Basic Information
| Provider Information | |||||||||
| NPI: | 1366610297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEEDHAM | ||||||||
| FirstName: | NATALIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 TAYLOR RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361173513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372799333 | ||||||||
| FaxNumber: | 3342799381 | ||||||||
| Practice Location | |||||||||
| Address1: | 699 CHURCH ST NE STE 300 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704228700 | ||||||||
| FaxNumber: | 7704257601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2008 | ||||||||
| LastUpdateDate: | 05/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 31900 | AL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | PENDING | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1026069 | 05 | LA | MEDICAID | 102I160836 | 01 | MEDICARE | OTHER | 000143099 | 05 | AL | MEDICAID | 300034164A | 05 | GA | MEDICAID | GRP3569 | 01 | GA | OPTOUT | OTHER |