Provider Demographics
NPI:1194776674
Name:GWINNETT OB-GYN ASSOCIATES, P.C..
Entity type:Organization
Organization Name:GWINNETT OB-GYN ASSOCIATES, P.C..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-972-0330
Mailing Address - Street 1:1700 TREE LANE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-972-0330
Mailing Address - Fax:770-985-2683
Practice Address - Street 1:1700 TREE LANE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-972-0330
Practice Address - Fax:770-985-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055000257AMedicaid
CA866OtherRAILROAD MEDICARE
GA055000257AMedicaid