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General NPI Number Information
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NPI Number | 1407023005
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Entity Type | Organization
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Legal Business Name | EXECUTIVE OB-GYN, PC
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 635 GOLDENWOOD CT
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6406
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Country | US
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Telephone | 770-795-0850
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Fax | 770-429-0446
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Provider Business Mailing Address
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Address Line | 635 GOLDENWOOD CT
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6406
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Country | US
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Telephone | 770-795-0850
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Fax | 770-429-0446
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEBRA TOLLEY WHELAN
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Credential | M.S.N., C.N.M.
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Telephone | 770-795-0850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | R59280
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License Number State | GA
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