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General NPI Number Information
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NPI Number | 1598895500
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Entity Type | Organization
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Legal Business Name | HERITAGE OB GYN, PC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 668 LANIER PARK DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-2061
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Country | US
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Telephone | 770-531-1515
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Fax | 770-538-0517
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Provider Business Mailing Address
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Address Line | 668 LANIER PARK DR
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City | GAINESVILLE
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State | GA
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Zip | 30501-2061
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Country | US
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Telephone | 770-531-1515
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Fax | 770-538-0517
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | ANGELA Y ANDERSON
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Credential |
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Telephone | 770-531-1515
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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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