Healthcare Provider Details

I. General information

NPI: 1982950069
Provider Name (Legal Business Name): GENESYS GYN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 GREENCASTLE RD
TYRONE GA
30290-2944
US

IV. Provider business mailing address

245 GREENCASTLE RD
TYRONE GA
30290-2944
US

V. Phone/Fax

Practice location:
  • Phone: 770-486-0353
  • Fax: 770-486-6200
Mailing address:
  • Phone: 770-486-0353
  • Fax: 770-486-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. VERNA A THORNTON
Title or Position: OWNER
Credential: M.D.
Phone: 770-486-0353