Basic Information
| Provider Information | |||||||||
| NPI: | 1932607868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATHENS OB GYN II, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 468329 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311468329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049430205 | ||||||||
| FaxNumber: | 4049430209 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 PRINCE AVE STE 3 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306065903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065484272 | ||||||||
| FaxNumber: | 7065489181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2018 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| AuthorizedOfficialLastName: | DEPP | ||||||||
| AuthorizedOfficialFirstName: | SHELLEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PAYER RELATIONS LIAISON | ||||||||
| AuthorizedOfficialTelephone: | 7705792626 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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.