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General NPI Number Information
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NPI Number | 1821082645
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Entity Type | Organization
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Legal Business Name | ETOWAH VALLEY OBSTETRICS & GYNECOLOGY, P.C.
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 970 JOE FRANK HARRIS PKWY SE SUITE 200
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2159
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Country | US
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Telephone | 770-382-5611
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Fax | 770-382-8381
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Provider Business Mailing Address
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Address Line | 970 JOE FRANK HARRIS PKWY SE SUITE 200
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2159
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Country | US
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Telephone | 770-382-5611
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Fax | 770-382-8381
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DAVID BEN WARREN
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Credential | M.D.
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Telephone | 770-382-5611
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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 | 032492
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License Number State | GA
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