Healthcare Provider Details

I. General information

NPI: 1780254201
Provider Name (Legal Business Name): CENTRO PRENATAL DE NORCROSS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5195 JIMMY CARTER BLVD STE 100
NORCROSS GA
30093-1649
US

IV. Provider business mailing address

5195 JIMMY CARTER BLVD STE 100
NORCROSS GA
30093-1649
US

V. Phone/Fax

Practice location:
  • Phone: 470-514-5818
  • Fax: 770-734-9793
Mailing address:
  • Phone: 470-514-5818
  • Fax:

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: MRS. ROSALBA GOMEZ
Title or Position: CEO
Credential:
Phone: 678-492-8477