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General NPI Number Information
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NPI Number | 1962695866
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Entity Type | Organization
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Legal Business Name | ATLANTA GYN CENTER
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Dates
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Enumeration Date | 08/23/2007
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Last Update Date | 11/07/2007
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Provider Practice Location Address
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Address Line | 1922 NORTHLAKE PKWY
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City | TUCKER
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State | GA
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Zip | 30084-7009
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Country | US
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Telephone | 770-723-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 1922 NORTHLAKE PKWY
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City | TUCKER
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State | GA
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Zip | 30084-7009
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Country | US
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Telephone | 770-723-1545
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RITA SHARMA
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Credential |
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Telephone | 770-723-1545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 50440
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License Number State | GA
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