Healthcare Provider Details

I. General information

NPI: 1164858122
Provider Name (Legal Business Name): PLANNED PARENTHOOD SOUTHEAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 DOWNTOWNER LOOP W
MOBILE AL
36609-5503
US

IV. Provider business mailing address

241 PEACHTREE ST NE STE 400
ATLANTA GA
30303-1423
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-6695
  • Fax: 251-342-8999
Mailing address:
  • Phone: 404-688-9300
  • Fax: 404-688-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA GAGANIS
Title or Position: REVENUE MANAGER
Credential:
Phone: 404-567-8354