Healthcare Provider Details

I. General information

NPI: 1588698427
Provider Name (Legal Business Name): EAST METRO OB GYN SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6142 GORDY STREET
COVINGTON GA
30014
US

IV. Provider business mailing address

PO BOX 1508
COVINGTON GA
30015-1508
US

V. Phone/Fax

Practice location:
  • Phone: 470-444-1501
  • Fax: 470-444-1406
Mailing address:
  • Phone: 470-444-1501
  • Fax: 470-444-1506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number00001733
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: SHARON HODGES
Title or Position: OWNER
Credential: MD
Phone: 470-444-1501