Healthcare Provider Details

I. General information

NPI: 1962695866
Provider Name (Legal Business Name): ATLANTA GYN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 NORTHLAKE PKWY
TUCKER GA
30084-7009
US

IV. Provider business mailing address

1922 NORTHLAKE PKWY
TUCKER GA
30084-7009
US

V. Phone/Fax

Practice location:
  • Phone: 770-723-1545
  • Fax:
Mailing address:
  • Phone: 770-723-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number50440
License Number StateGA

VIII. Authorized Official

Name: DR. RITA SHARMA
Title or Position: PRESIDENT
Credential:
Phone: 770-723-1545