Provider Demographics
NPI:1558776518
Name:WOMEN OF CAMDEN ADVANCED OBGYN
Entity type:Organization
Organization Name:WOMEN OF CAMDEN ADVANCED OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-510-7376
Mailing Address - Street 1:2060 DAN PROCTOR DR STE 1800
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3895
Mailing Address - Country:US
Mailing Address - Phone:912-510-7376
Mailing Address - Fax:912-510-7377
Practice Address - Street 1:2060 DAN PROCTOR DR STE 1800
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4324
Practice Address - Country:US
Practice Address - Phone:912-510-7376
Practice Address - Fax:912-510-7377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53017207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH86262Medicare UPIN