Provider Demographics
NPI:1285902197
Name:HERITAGE OBGYN
Entity type:Organization
Organization Name:HERITAGE OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-531-1515
Mailing Address - Street 1:668 LANIER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2061
Mailing Address - Country:US
Mailing Address - Phone:770-531-1515
Mailing Address - Fax:770-531-1930
Practice Address - Street 1:2695 OLD WINDER HWY
Practice Address - Street 2:STE 250
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-6075
Practice Address - Country:US
Practice Address - Phone:770-965-4170
Practice Address - Fax:770-965-4171
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE OBGYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty