Provider Demographics
NPI:1316136682
Name:MIDTOWN GYN ONCOLOGY LLC
Entity type:Organization
Organization Name:MIDTOWN GYN ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-265-4478
Mailing Address - Street 1:2107 N DECATUR RD
Mailing Address - Street 2:SUITE 471
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:404-265-4478
Mailing Address - Fax:404-265-4479
Practice Address - Street 1:320 PARKWAY DR NE
Practice Address - Street 2:SUITE 244
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1213
Practice Address - Country:US
Practice Address - Phone:404-265-4478
Practice Address - Fax:404-265-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032209207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000401684JMedicaid
5687560001Medicare NSC
GA000401684JMedicaid