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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
ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
241 SILVERWOOD COMMERCIAL DR, RINCON, GA 31326-5164
(912) 350-5937
(912) 350-3483
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 350-5937
(912) 350-3483
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
NULL
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
11/30/2006
Last updated
06/01/2011
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