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General NPI Number Information
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NPI Number | 1609198290
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Entity Type | Organization
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Legal Business Name | ATLANTIC OB/GYN, INC
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Dates
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Enumeration Date | 02/23/2010
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Last Update Date | 02/23/2010
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Provider Practice Location Address
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Address Line | 1110 BROAD AVE SUITE 100
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City | GULFPORT
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State | MS
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Zip | 39501-8907
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Country | US
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Telephone | 228-871-5047
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 BROAD AVE SUITE 100
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City | GULFPORT
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State | MS
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Zip | 39501-8907
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Country | US
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Telephone | 228-871-5047
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL A GORDON
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Credential | MD
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Telephone | 228-871-5047
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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 | 16172
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License Number State | MS
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