Healthcare Provider Details

I. General information

NPI: 1396970109
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF ATLANTA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 PEACHTREE ROAD SUITE 303
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-5119
  • Fax: 404-352-5330
Mailing address:
  • Phone: 800-243-3839
  • Fax: 844-686-2961

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: MR. JORGE DEL TORO
Title or Position: SECRETARY
Credential: MD
Phone: 954-384-0175