Healthcare Provider Details

I. General information

NPI: 1467128462
Provider Name (Legal Business Name): PREMIERE PERINATAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 S UNIVERSITY DR
DAVIE FL
33328-2000
US

IV. Provider business mailing address

PO BOX 935190
ATLANTA GA
31193-5190
US

V. Phone/Fax

Practice location:
  • Phone: 877-328-1119
  • Fax:
Mailing address:
  • Phone: 877-328-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 973-251-1132