MEDICARE: SYLACAUGA OBSTETRICS AND GYNECOLOGY, PC

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	28010	AL

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	:	1639372907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLACAUGA OBSTETRICS AND GYNECOLOGY, PC

Provider Business Mailing Address
First Line	:	315 W FORT WILLIAMS ST STE 100
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2433
Country	:	US
Telephone Number	:	256-249-6995
Fax Number	:	256-245-6992

Provider Business Practice Location Address
First Line	:	315 W FORT WILLIAMS ST STE 100
Second Line	:
City	:	SYLACAUGA
State	:	AL
Zip	:	35150-2433
Country	:	US
Telephone Number	:	256-249-6995
Fax Number	:	256-245-6992

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONATHAN FRANCIS REHBERG
Credential	:	MD
Telephone Number	:	256-249-6995

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	03/17/2018

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1376045963 — MRS. KYNDRA P WRIGHT CRNP
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1679272033 — LAUREN LUKER PERRY WHNP
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