Basic Information
| Provider Information | |||||||||
| NPI: | 1073765079 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PAULSEN OB GYN | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5354 REYNOLDS ST | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123552800 | ||||||||
| FaxNumber: | 9123559444 | ||||||||
| Practice Location | |||||||||
| Address1: | 5354 REYNOLDS ST | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123552800 | ||||||||
| FaxNumber: | 9123559444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2008 | ||||||||
| LastUpdateDate: | 09/14/2011 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | REGINALD | ||||||||
| AuthorizedOfficialMiddleName: | JEROME | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9123552800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 46638 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00813084A | 05 | GA | MEDICAID |