1831606714 NPI number — NORTH PARK OB-GYN ASSOCIATED 2, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831606714 NPI number — NORTH PARK OB-GYN ASSOCIATED 2, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH PARK OB-GYN ASSOCIATED 2, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831606714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 468329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31146-8329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-943-0205
Provider Business Mailing Address Fax Number:
404-943-0209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 HAMILL RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIXSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37343-4653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-877-4549
Provider Business Practice Location Address Fax Number:
423-875-8510
Provider Enumeration Date:
01/02/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DEPP
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PAYER RELATIONS LIAISON
Authorized Official Telephone Number:
770-579-2626

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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