Organization
PREMIER WOMENS OBGYN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TRACEY BLANDER (PRACTICE MANAGEMENT CONSULTANT)
(770) 716-6203
Entity
Organization
Contact information
Practice address
237 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2537
(770) 909-5003
(770) 909-5004
Mailing address
237 UPPER RIVERDALE RD SW, RIVERDALE, GA 30274-2537
(770) 909-5003
(770) 909-5004
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
054127
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
547811054A
—
GA
Enumeration date
06/17/2007
Last updated
03/04/2020
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