Basic Information
| Provider Information | |||||||||
| NPI: | 1639114556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PERIMETER OB/GYN CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3025 BRECKINRIDGE BLVD | ||||||||
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| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782260082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1462 MONTREAL RD | ||||||||
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| City: | TUCKER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300846932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703963496 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | PANCER | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7703962496 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 040187 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.