Healthcare Provider Details

I. General information

NPI: 1972715977
Provider Name (Legal Business Name): GRAND BLANC OBSTETRICS & GYNECOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 HOLLY RD STE B
GRAND BLANC MI
48439-2487
US

IV. Provider business mailing address

8423 HOLLY RD STE B
GRAND BLANC MI
48439-2487
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-7095
  • Fax: 810-694-7224
Mailing address:
  • Phone: 810-694-7095
  • Fax: 810-694-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4301075129
License Number StateMI

VIII. Authorized Official

Name: DR. MATTIE SCOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 810-694-7095