# MPPG, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Provident OB/GYN Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245544519
- **Authorized official:** MS. SEBRENA HOLMES GIBSON (PROVIDER ENROLLMENT COORDINATOR)
- **Authorized official phone:** (912) 350-9335

## Contact information

- **Practice address:** 3780 US HIGHWAY 17, RICHMOND HILL, GA 31324-3378
- **Practice address phone:** (912) 756-2292
- **Practice address fax:** (912) 756-2289
- **Mailing address:** PO BOX 102032, ATLANTA, GA 30368-2032
- **Mailing address phone:** (912) 350-7020
- **Mailing address fax:** (912) 756-2427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/29/2010
- **Last updated:** 06/20/2016