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General NPI Number Information
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NPI Number | 1649225517
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Entity Type | Organization
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Legal Business Name | EAGLES LANDING OB GYN ASSOCIATES, PC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 3333 JODECO RD STE D
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City | MCDONOUGH
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State | GA
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Zip | 30253-5319
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Country | US
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Telephone | 404-455-0110
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Fax | 770-474-7832
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Provider Business Mailing Address
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Address Line | 3333 JODECO RD STE D
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City | MCDONOUGH
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State | GA
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Zip | 30253-5319
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Country | US
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Telephone | 770-474-1919
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Fax | 770-474-7832
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JACKIE LIVINGSTON
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Credential |
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Telephone | 770-474-1919
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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 | 036810
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 043639
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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 | 046612
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 042399
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 057739
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 056295
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 65352
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License Number State | GA
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Taxonomy #8
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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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Taxonomy #9
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN070819 NP
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License Number State | GA
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Taxonomy #10
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | RN119659
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License Number State | GA
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Taxonomy #11
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 032893
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License Number State | GA
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