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General NPI Number Information
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NPI Number | 1033324629
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Entity Type | Organization
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Legal Business Name | OGEECHEE OBGYN, P.C.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 1310 BRAMPTON AVE
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City | STATESBORO
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State | GA
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Zip | 30458-0851
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Country | US
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Telephone | 912-871-6206
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Fax | 912-681-8558
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Provider Business Mailing Address
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Address Line | 1310 BRAMPTON AVE
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City | STATESBORO
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State | GA
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Zip | 30458-0851
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Country | US
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Telephone | 912-871-6206
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TONYA K CLARK
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Credential |
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Telephone | 912-871-6206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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