Healthcare Provider Details

I. General information

NPI: 1396097549
Provider Name (Legal Business Name): OBSTETRICS & GYNECOLOGY SOUTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 COMMONS BLVD STE 200A
BEAVERCREEK OH
45431-3829
US

IV. Provider business mailing address

3533 SOUTHERN BLVD STE 4600
KETTERING OH
45429-1264
US

V. Phone/Fax

Practice location:
  • Phone: 937-558-3088
  • Fax:
Mailing address:
  • Phone: 937-296-0167
  • Fax: 937-297-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35.043084
License Number StateOH

VIII. Authorized Official

Name: ART ALTMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 937-296-0167