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General NPI Number Information
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NPI Number | 1629390133
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Entity Type | Organization
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Legal Business Name | DOURRON WOMEN'S SPECIALIST
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 12/11/2010
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Provider Practice Location Address
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Address Line | 253 UPPER RIVERDALE RD SW SUITE B
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City | RIVERDALE
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State | GA
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Zip | 30274-4945
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Country | US
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Telephone | 678-381-1531
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Fax | 678-990-3767
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Provider Business Mailing Address
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Address Line | 253 UPPER RIVERDALE RD SW SUITE B
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City | RIVERDALE
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State | GA
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Zip | 30274-4945
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Country | US
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Telephone | 678-381-1531
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Fax | 678-990-3767
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. MARIA L DOURRON
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Credential | M.D.
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Telephone | 678-381-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 014308
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 014308
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 014308
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License Number State | GA
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