=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285765115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTA GYN ASSOCIATS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 12/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2550 WINDY HILL RD SE SUITE 115
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-980-1818
-----------------------------------------------------
Fax | 770-980-1873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2550 WINDY HILL RD SE SUITE 115
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067-8665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-980-1818
-----------------------------------------------------
Fax | 770-980-1873
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KRISTI MULCHAHEY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 770-980-1818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 034209
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------