Healthcare Provider Details

I. General information

NPI: 1467522623
Provider Name (Legal Business Name): HENRY FRED GOBER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD NE SUITE 580
ATLANTA GA
30342-1705
US

IV. Provider business mailing address

5505 PEACHTREE DUNWOODY RD NE SUITE 580
ATLANTA GA
30342-1705
US

V. Phone/Fax

Practice location:
  • Phone: 404-256-6336
  • Fax:
Mailing address:
  • Phone: 404-256-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number20432
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: