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General NPI Number Information
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NPI Number | 1831272988
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Entity Type | Organization
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Legal Business Name | OB-GYN ASSOCIATES OF WAYCROSS, PLLC
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 1206 ALICE STREET
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City | WAYCROSS
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State | GA
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Zip | 31501
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Country | US
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Telephone | 912-285-2620
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Fax | 912-285-7578
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Provider Business Mailing Address
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Address Line | 1206 ALICE STREET
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City | WAYCROSS
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State | GA
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Zip | 31501
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Country | US
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Telephone | 912-285-2620
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Fax | 912-285-7578
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN C. MALMBORG
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Credential | M.D.
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Telephone | 912-285-2620
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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 |
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License Number State |
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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 | 18925
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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 | 042055
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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 | 19074
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License Number State | GA
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