# PREMIER WOMENS OBGYN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083819429
- **Authorized official:** MRS. TRACEY BLANDER (PRACTICE MANAGEMENT CONSULTANT)
- **Authorized official phone:** (770) 716-6203

## Contact information

- **Practice address:** 237 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2537
- **Practice address phone:** (770) 909-5003
- **Practice address fax:** (770) 909-5004
- **Mailing address:** 237 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2537
- **Mailing address phone:** (770) 909-5003
- **Mailing address fax:** (770) 909-5004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 054127 | GA | Yes |

## Other

- **Enumeration date:** 06/17/2007
- **Last updated:** 03/04/2020