# MPPG, INC.

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

## Provider details

- **NPI number:** 1669602280
- **Authorized official:** MRS. ROBIN J MADDOX (PROVIDER ENROLLMENT COORDINATOR)
- **Authorized official phone:** (912) 350-9335

## Contact information

- **Practice address:** 1004 MEMORIAL LN, SUITE 500, SAVANNAH, GA 31410-1254
- **Practice address phone:** (912) 897-4604
- **Practice address fax:** (912) 897-4608
- **Mailing address:** PO BOX 102032, ATLANTA, GA 30368-2032
- **Mailing address phone:** (912) 897-4604
- **Mailing address fax:** (912) 897-4608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VG0400X | Gynecology Physician | — | NULL | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 07/16/2009
- **Last updated:** 06/01/2011