Healthcare Provider Details

I. General information

NPI: 1457441644
Provider Name (Legal Business Name): CINDY O'BRYANT GARTMOND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 BRAMPTON AVE
STATESBORO GA
30458-0855
US

IV. Provider business mailing address

215 N COLEMAN ST
SWAINSBORO GA
30401-3530
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-9196
  • Fax: 912-764-8401
Mailing address:
  • Phone: 478-299-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number037545
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: