MEDICARE: ASSERTIVE OB GYN

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	207V00000X	Obstetrics & Gynecology Physician

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

General Provider Information

NPI Number	:	1588975064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSERTIVE OB GYN

Provider Business Mailing Address
First Line	:	10800 ALPHARETTA HWY
Second Line	:	SUITE 208 553
City	:	ROSWELL
State	:	GA
Zip	:	30076-1490
Country	:	US
Telephone Number	:	770-817-1970
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 MARKET PLACE BLVD
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7927
Country	:	US
Telephone Number	:	770-298-8877
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ROD REDMON
Credential	:
Telephone Number	:	770-817-1970

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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