Organization
FITZGERALD OB/GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TONYA LEANNE PARHAM (OFFICE MANAGER)
(229) 424-7685
Entity
Organization
Contact information
Practice address
808 S GRANT ST, FITZGERALD, GA 31750-3703
(229) 426-7685
Mailing address
PO BOX 1027, FITZGERALD, GA 31750-1027
(229) 426-7685
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
046468
GA
363L00000X
Nurse Practitioner
RN101986 NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000837669A
—
GA
05
—
173496898B
—
GA
Enumeration date
11/06/2007
Last updated
07/15/2008
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