Healthcare Provider Details

I. General information

NPI: 1609916337
Provider Name (Legal Business Name): DUBLIN OB-GYN & ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ERIN OFFICE PARK 2400 BELLEVUE ROAD
DUBLIN GA
31021-2866
US

IV. Provider business mailing address

23 ERIN OFFICE PARK 2400 BELLEVUE ROAD
DUBLIN GA
31021-2866
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-8580
  • Fax: 478-275-0012
Mailing address:
  • Phone: 478-272-8580
  • Fax: 478-275-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number017714
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number017442
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number052127
License Number StateGA

VIII. Authorized Official

Name: MRS. JENNIFER P SIMONS
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 478-272-8580