Provider Demographics
NPI:1568646255
Name:GYNECOLOGY SPECIALISTS OF ATLANTA
Entity type:Organization
Organization Name:GYNECOLOGY SPECIALISTS OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:BRASIEL
Authorized Official - Suffix:
Authorized Official - Credentials:CDT
Authorized Official - Phone:678-417-6319
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:678-417-6319
Mailing Address - Fax:678-417-6627
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 270
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:678-417-6319
Practice Address - Fax:678-417-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013182207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6283Medicare PIN