Healthcare Provider Details

I. General information

NPI: 1316136682
Provider Name (Legal Business Name): MIDTOWN GYN ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PARKWAY DR NE SUITE 244
ATLANTA GA
30312-1213
US

IV. Provider business mailing address

2107 N DECATUR RD SUITE 471
DECATUR GA
30033-5305
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4478
  • Fax: 404-265-4479
Mailing address:
  • Phone: 404-265-4478
  • Fax: 404-265-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number032209
License Number StateGA

VIII. Authorized Official

Name: DR. SARAH L HOSFORD
Title or Position: OWNER
Credential: MD
Phone: 404-265-4478