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General NPI Number Information
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NPI Number | 1790066314
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Entity Type | Organization
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Legal Business Name | PHOEBE DORMINY OB/GYN ASSOCIATES
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 119 NORMAN DORMINY DR STE B
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City | FITZGERALD
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State | GA
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Zip | 31750-8855
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Country | US
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Telephone | 229-426-7685
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Fax |
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Provider Business Mailing Address
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Address Line | 500 W 3RD AVE STE 101
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City | ALBANY
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State | GA
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Zip | 31701-1985
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Country | US
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Telephone | 229-312-5800
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Fax |
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Authorized Official
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Title or Position | SR VP PHYSICIAN PRACTICES
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Name | ROBERT LAGESSE
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Credential |
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Telephone | 229-312-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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