Basic Information
| Provider Information | |||||||||
| NPI: | 1922214931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH POINTE OB GYN ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 102805 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303682805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 NORTHSIDE FORSYTH DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300418447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 08/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | LAMBERT | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7708863555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 300033097A | 05 | GA | MEDICAID |