Organization
OGEECHEE OBGYN, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA K CLARK (OFFICE MANAGER)
(912) 871-6206
Entity
Organization
Contact information
Practice address
1310 BRAMPTON AVE, STATESBORO, GA 30458-0851
(912) 871-6206
(912) 681-8558
Mailing address
1310 BRAMPTON AVE, STATESBORO, GA 30458-0851
(912) 871-6206
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300019870A
MEDICAID GROUP
GA
Enumeration date
05/14/2007
Last updated
06/15/2021
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