Healthcare Provider Details

I. General information

NPI: 1386884138
Provider Name (Legal Business Name): GENESYS OB/GYN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 GREENCASTLE ROAD
TYRONE GA
30290
US

IV. Provider business mailing address

245 GREENCASTLE ROAD
TYRONE GA
30290
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 Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number034512
License Number StateGA

VIII. Authorized Official

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