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Organization
MPPG, INC.
Active
Organization
MPPG, INC.
Active
Other names
Provident OB/GYN Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SEBRENA HOLMES GIBSON (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
3780 US HIGHWAY 17, RICHMOND HILL, GA 31324-3378
(912) 756-2292
(912) 756-2289
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 350-7020
(912) 756-2427
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
07/29/2010
Last updated
06/20/2016
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