MEDICARE: LIFE CYCLE OBGYN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	053504	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467664276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE CYCLE OBGYN, LLC

Provider Business Mailing Address
First Line	:	2739 FELTON DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3603
Country	:	US
Telephone Number	:	404-766-8371
Fax Number	:

Provider Business Practice Location Address
First Line	:	2739 FELTON DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3603
Country	:	US
Telephone Number	:	404-766-8371
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ANNE SIGOUIN
Credential	:
Telephone Number	:	404-766-8371

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	03/18/2008

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Directions to “LIFE CYCLE OBGYN, LLC ” Practice Location

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