Healthcare Provider Details

I. General information

NPI: 1518012863
Provider Name (Legal Business Name): LAGRANGE OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CHURCH ST SUITE A
LAGRANGE GA
30240-2700
US

IV. Provider business mailing address

307 CHURCH ST SUITE A
LAGRANGE GA
30240-2700
US

V. Phone/Fax

Practice location:
  • Phone: 706-812-2229
  • Fax: 706-882-6455
Mailing address:
  • Phone: 706-812-2229
  • Fax: 706-882-6455

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: DR. BRIAN STEPHEN CHADWICK
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 706-812-2229