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General NPI Number Information
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NPI Number | 1447461488
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN OB-GYN, P.C.
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2801 PARKWOOD DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-4730
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Country | US
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Telephone | 912-264-9118
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Fax | 912-264-1904
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Provider Business Mailing Address
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Address Line | 2801 PARKWOOD DR
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City | BRUNSWICK
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State | GA
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Zip | 31520-4730
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Country | US
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Telephone | 912-264-9118
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Fax | 912-264-1904
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JEANNIE M BATTEN
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Credential |
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Telephone | 912-264-9118
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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 | 051407
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 038105
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License Number State | GA
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