MEDICARE: MY OBGYN PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	044077	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669534210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY OBGYN PC

Provider Business Mailing Address
First Line	:	PO BOX 962380
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30296-6921
Country	:	US
Telephone Number	:	770-996-1200
Fax Number	:	770-907-2334

Provider Business Practice Location Address
First Line	:	81 UPPER RIVERDALE RD
Second Line	:	SUITE 210
City	:	RIVERDALE
State	:	GA
Zip	:	30274-2627
Country	:	US
Telephone Number	:	770-996-1200
Fax Number	:	770-907-7492

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	LETITIA D ROYSTER
Credential	:	M.D.
Telephone Number	:	770-996-1200

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/09/2012

Similar Medicare Providers

1356425292 — LETITIA D ROYSTER MD
Practice Location Address:

81 UPPER RIVERDALE RD , SUITE 210
RIVERDALE, GA
30274-2627

Practice Phone: 770-996-1200
Practice Fax: 770-907-7492

1073697801 — DR. NEIL S GLADSTONE MD
Practice Location Address:

81 UPPER RIVERDALE RD , SUITE 210
RIVERDALE, GA
30274-2627

Practice Phone: 770-996-1200
Practice Fax: 770-907-7492

1093276263 — PARIS CANNON MCALLISTER
Practice Location Address:

81 UPPER RIVERDALE RD SW STE 210
RIVERDALE, GA
30274-2627

Practice Phone: 770-996-1200
Practice Fax:

1912555939 — ERIKA PARKS NP
Practice Location Address:

81 UPPER RIVERDALE RD SW STE 210
RIVERDALE, GA
30274-2627

Practice Phone: 770-996-1200
Practice Fax:

1851934590 — ROSALIND FAITH GARDNER CNM
Practice Location Address:

81 UPPER RIVERDALE RD SW STE 210
RIVERDALE, GA
30274-2627

Practice Phone: 770-996-1200
Practice Fax:

1881286185 — YANNIQUE TELLO CNM
Practice Location Address:

81 UPPER RIVERDALE RD SW STE 210
RIVERDALE, GA
30274-2627

Practice Phone: 770-996-1200
Practice Fax:

Directions to “MY OBGYN PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.