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General NPI Number Information
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NPI Number | 1265577159
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Entity Type | Organization
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Legal Business Name | NOVA OBGYN, PC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1587 PHOENIX BLVD SUITE6
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5540
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Country | US
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Telephone | 770-994-6806
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Fax | 770-994-6807
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Provider Business Mailing Address
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Address Line | 1587 PHOENIX BLVD SUITE6
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5540
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Country | US
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Telephone | 770-994-6806
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Fax | 770-994-6807
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. NELDA CORSON
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Credential |
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Telephone | 770-994-6806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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