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Organization

EXECUTIVE OB-GYN, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. DEBRA TOLLEY WHELAN M.S.N., C.N.M. (PRESIDENT)
(770) 795-0850
Entity
Organization

Contact information

Practice address
635 GOLDENWOOD CT, POWDER SPRINGS, GA 30127-6406
(770) 795-0850
(770) 429-0446
Mailing address
635 GOLDENWOOD CT, POWDER SPRINGS, GA 30127-6406
(770) 795-0850
(770) 429-0446

Taxonomy

Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
R59280
GA

Other

Enumeration date
05/13/2008
Last updated
05/13/2008
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