Healthcare Provider Details

I. General information

NPI: 1467683342
Provider Name (Legal Business Name): GYN & OB OF DEKALB, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 PARKE PLAZA CIR SUITE 102
STONE MOUNTAIN GA
30087-3637
US

IV. Provider business mailing address

2801 N DECATUR RD SUITE 190
DECATUR GA
30033-5949
US

V. Phone/Fax

Practice location:
  • Phone: 770-469-9961
  • Fax: 770-413-0030
Mailing address:
  • Phone: 404-299-9307
  • Fax: 404-299-9309

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: DR. WILLIAM LANE HUTCHINSON
Title or Position: PRESIDENT
Credential: MD
Phone: 404-299-9307