Basic Information
| Provider Information | |||||||||
| NPI: | 1144396581 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OB-GYN ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 699 CHURCH ST NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704228700 | ||||||||
| FaxNumber: | 7704257601 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 STONEFOREST DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301894880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6784453555 | ||||||||
| FaxNumber: | 6784457358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 10/21/2011 | ||||||||
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| AuthorizedOfficialLastName: | ESPY | ||||||||
| AuthorizedOfficialFirstName: | GOODMAN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7704228700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.