Basic Information
| Provider Information | |||||||||
| NPI: | 1831311182 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERBEND OB-GYN & COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE STE D360 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042501350 | ||||||||
| FaxNumber: | 4042501359 | ||||||||
| Practice Location | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE STE D360 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042501350 | ||||||||
| FaxNumber: | 4042501359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOTT | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4042501350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 0033314 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2287623 | 01 | AETNA | OTHER | 0700440 | 01 | GA | EVERCARE | OTHER | P4060754 | 01 | AETNA | OTHER | 303425 | 01 | GA | WELLCARE MEDICAID | OTHER | 597401 | 01 | GA | CIGNA | OTHER | 803545 | 01 | GA | BLUE CROSS | OTHER |