Provider Demographics
NPI:1972594778
Name:HENRY OB/GYN ASSOCIATES, PC.
Entity type:Organization
Organization Name:HENRY OB/GYN ASSOCIATES, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SATYA (SONIA)
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUDDALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-389-8520
Mailing Address - Street 1:135 EAGLES WALK
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7206
Mailing Address - Country:US
Mailing Address - Phone:770-389-8520
Mailing Address - Fax:770-389-3848
Practice Address - Street 1:135 EAGLES WALK
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7206
Practice Address - Country:US
Practice Address - Phone:770-389-8520
Practice Address - Fax:770-389-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4133174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4363Medicare ID - Type UnspecifiedGROUP #