# EAGLES LANDING OB GYN ASSOCIATES, PC

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

## Provider details

- **NPI number:** 1649225517
- **Authorized official:** JACKIE LIVINGSTON (OFFICE MANAGER)
- **Authorized official phone:** (770) 474-1919

## Contact information

- **Practice address:** 3333 JODECO RD STE D, MCDONOUGH, GA 30253-5319
- **Practice address phone:** (404) 455-0110
- **Practice address fax:** (770) 474-7832
- **Mailing address:** 3333 JODECO RD STE D, MCDONOUGH, GA 30253-5319
- **Mailing address phone:** (770) 474-1919
- **Mailing address fax:** (770) 474-7832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 032893 | GA | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | 036810 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 042399 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 043639 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 046612 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 056295 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 057739 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | 65352 | GA | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 363LW0102X | Women's Health Nurse Practitioner | RN070819 NP | GA | — |
| 367A00000X | Advanced Practice Midwife | RN119659 | GA | — |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 01/31/2024