Healthcare Provider Details

I. General information

NPI: 1194776674
Provider Name (Legal Business Name): GWINNETT OB-GYN ASSOCIATES, P.C..
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 TREE LANE RD SUITE 290
SNELLVILLE GA
30078-6782
US

IV. Provider business mailing address

1700 TREE LANE RD SUITE 290
SNELLVILLE GA
30078-6782
US

V. Phone/Fax

Practice location:
  • Phone: 770-972-0330
  • Fax: 770-985-2683
Mailing address:
  • Phone: 770-972-0330
  • Fax: 770-985-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA GANN
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 770-972-0330