Healthcare Provider Details

I. General information

NPI: 1700131836
Provider Name (Legal Business Name): ATLANTA PREMIER OB/GYN ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2012
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

764 MEMORIAL DR SE STE 101
ATLANTA GA
30316-1573
US

IV. Provider business mailing address

764 MEMORIAL DR SE STE 101
ATLANTA GA
30316-1573
US

V. Phone/Fax

Practice location:
  • Phone: 678-705-4900
  • Fax: 678-705-5441
Mailing address:
  • Phone: 678-705-4900
  • Fax: 678-705-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number064644
License Number StateGA

VIII. Authorized Official

Name: DR. TOSHA ROGERS
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 678-705-4900