Organization
HERITAGE OB GYN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA Y ANDERSON (PRACTICE ADMINISTRATOR)
(770) 531-1515
Entity
Organization
Contact information
Practice address
668 LANIER PARK DR, GAINESVILLE, GA 30501-2061
(770) 531-1515
(770) 538-0517
Mailing address
668 LANIER PARK DR, GAINESVILLE, GA 30501-2061
(770) 531-1515
(770) 538-0517
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP2489
MEDICARE GROUP NUMBER
GA
Enumeration date
03/07/2007
Last updated
12/10/2007
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