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General NPI Number Information
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NPI Number | 1750458261
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Entity Type | Organization
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Legal Business Name | SPECIALTY GYNECOLOGY PC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 2398 MOUNT VERNON RD SUITE 150
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City | DUNWOODY
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State | GA
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Zip | 30338-3064
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Country | US
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Telephone | 770-512-7099
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Fax | 770-512-7090
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Provider Business Mailing Address
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Address Line | 2398 MOUNT VERNON RD SUITE 150
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City | DUNWOODY
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State | GA
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Zip | 30338-3064
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Country | US
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Telephone | 770-512-7099
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Fax | 770-512-7090
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. JACQUELINE CHRISTINE CASTAGNO
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Credential | MD
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Telephone | 352-672-4666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 031498
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 044759
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License Number State | GA
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