Healthcare Provider Details

I. General information

NPI: 1972594778
Provider Name (Legal Business Name): HENRY OB/GYN ASSOCIATES, PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 EAGLES WALK SUITE 200
STOCKBRIDGE GA
30281-7206
US

IV. Provider business mailing address

135 EAGLES WALK SUITE 200
STOCKBRIDGE GA
30281-7206
US

V. Phone/Fax

Practice location:
  • Phone: 770-389-8520
  • Fax: 770-389-3848
Mailing address:
  • Phone: 770-389-8520
  • Fax: 770-389-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4133
License Number StateGA

VIII. Authorized Official

Name: MRS. SATYA (SONIA) R. SUDDALA
Title or Position: OWNER ADMINISTRATOR
Credential: M.D.
Phone: 770-389-8520