Organization
OGEECHEE OB-GYN, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA KAY CLARK (OFFICE MANAGER)
(912) 871-6206
Entity
Organization
Contact information
Practice address
1497 FAIR RD, SUITE 300, STATESBORO, GA 30458-0822
(912) 871-6206
(912) 681-8558
Mailing address
1497 FAIR RD, SUITE 300, STATESBORO, GA 30458-0822
(912) 871-6206
(912) 681-8558
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
056210
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056210
LICENSE
GA
01
—
1053380592
NPI
GA
Enumeration date
03/16/2006
Last updated
08/22/2020
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