MEDICARE: DEKALB OBGYN AFFILIATES 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	207V00000X	Obstetrics & Gynecology Physician	05869	GA

General Provider Information

NPI Number	:	1730564709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEKALB OBGYN AFFILIATES LLC

Provider Business Mailing Address
First Line	:	4480 N SHALLOWFORD RD STE 200
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6410
Country	:	US
Telephone Number	:	470-226-1601
Fax Number	:	470-225-6345

Provider Business Practice Location Address
First Line	:	4480 N SHALLOWFORD RD STE 200
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6410
Country	:	US
Telephone Number	:	470-226-1601
Fax Number	:	470-225-6345

Authorized Official
Title or Position	:	PHYSICIAN/CEO
Name	:	SHIRLEY RIGAUD-ECHOLS
Credential	:	MD
Telephone Number	:	470-226-1601

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	02/08/2024

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