Provider Demographics
NPI:1063519742
Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES OF AUGUSTA, PC
Entity type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY ASSOCIATES OF AUGUSTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-724-2261
Mailing Address - Street 1:1430 HARPER ST
Mailing Address - Street 2:BUILDING A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0617
Mailing Address - Country:US
Mailing Address - Phone:706-724-2261
Mailing Address - Fax:706-724-2523
Practice Address - Street 1:1430 HARPER ST
Practice Address - Street 2:BUILDING A
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-0617
Practice Address - Country:US
Practice Address - Phone:706-724-2261
Practice Address - Fax:706-724-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2397Medicare ID - Type Unspecified