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General NPI Number Information
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NPI Number | 1891864724
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Entity Type | Organization
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Legal Business Name | EAST ATLANTA GYNECOLOGY ASSOCIATES PC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5900 HILLANDALE DR SUITE 255
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City | LITHONIA
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State | GA
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Zip | 30058-3802
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Country | US
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Telephone | 770-593-8866
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Fax | 404-501-8270
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Provider Business Mailing Address
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Address Line | 5900 HILLANDALE DR SUITE 255
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City | LITHONIA
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State | GA
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Zip | 30058-3802
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Country | US
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Telephone | 770-593-8866
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Fax | 404-501-8270
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Authorized Official
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Title or Position | CEO PHYSICIAN
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Name | RAY LASHUNT HOWELL
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Credential | MD,MBA,FACOG,FICS
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Telephone | 770-593-8866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 0341611
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License Number State | GA
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