Healthcare Provider Details

I. General information

NPI: 1366185696
Provider Name (Legal Business Name): REPRODUCTIVE ENDOCRINOLOGY & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEACHTREE ST NW STE 640
ATLANTA GA
30309-2555
US

IV. Provider business mailing address

1105 COLQUITT AVE NE
ATLANTA GA
30307-1921
US

V. Phone/Fax

Practice location:
  • Phone: 404-370-1817
  • Fax: 404-591-8909
Mailing address:
  • Phone: 404-370-1817
  • Fax: 404-591-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN R KAPLAN
Title or Position: OWNER
Credential: MD
Phone: 404-370-1817