# OGEECHEE OB-GYN, P.C.

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

## Provider details

- **NPI number:** 1134198104
- **Authorized official:** TONYA KAY CLARK (OFFICE MANAGER)
- **Authorized official phone:** (912) 871-6206

## Contact information

- **Practice address:** 1497 FAIR RD, SUITE 300, STATESBORO, GA 30458-0822
- **Practice address phone:** (912) 871-6206
- **Practice address fax:** (912) 681-8558
- **Mailing address:** 1497 FAIR RD, SUITE 300, STATESBORO, GA 30458-0822
- **Mailing address phone:** (912) 871-6206
- **Mailing address fax:** (912) 681-8558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LX0001X | Obstetrics & Gynecology Nurse Practitioner | RN069911 NP | GA | Yes |

## Other

- **Enumeration date:** 03/14/2006
- **Last updated:** 08/22/2020