Healthcare Provider Details

I. General information

NPI: 1457866535
Provider Name (Legal Business Name): LIFE CYCLE OB/GYN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 WINN CT
DECATUR GA
30030-1726
US

IV. Provider business mailing address

2739 FELTON DR
EAST POINT GA
30344-3603
US

V. Phone/Fax

Practice location:
  • Phone: 404-766-8371
  • Fax:
Mailing address:
  • Phone: 404-766-8371
  • Fax: 404-767-3926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNE SIREY SIGOUIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 404-405-4543