Provider Demographics
NPI:1427219542
Name:CENTRAL OBSTETRICS AND GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:CENTRAL OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:DAMASUS
Authorized Official - Last Name:UMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-507-6306
Mailing Address - Street 1:7141 MOON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7294
Mailing Address - Country:US
Mailing Address - Phone:706-507-6306
Mailing Address - Fax:706-507-6307
Practice Address - Street 1:7141 MOON RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7294
Practice Address - Country:US
Practice Address - Phone:706-507-6306
Practice Address - Fax:706-507-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA756283721AMedicaid