Healthcare Provider Details

I. General information

NPI: 1114115847
Provider Name (Legal Business Name): NEW MILLENNIUM OBSETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 UPPER RIVERDALE RD SW BLDG 2
RIVERDALE GA
30274-2636
US

IV. Provider business mailing address

83 UPPER RIVERDALE RD SW BLDG 2
RIVERDALE GA
30274-2636
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-0778
  • Fax: 770-991-7390
Mailing address:
  • Phone: 770-991-0778
  • Fax: 770-991-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number32110
License Number StateGA

VIII. Authorized Official

Name: TIMOTHY B BROWN
Title or Position: OWNER
Credential: M.D.
Phone: 770-991-0778