Organization
MY OBGYN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LETITIA D ROYSTER M.D. (VICE PRESIDENT)
(770) 996-1200
Entity
Organization
Contact information
Practice address
81 UPPER RIVERDALE RD, SUITE 210, RIVERDALE, GA 30274-2627
(770) 996-1200
(770) 907-7492
Mailing address
PO BOX 962380, RIVERDALE, GA 30296-6921
(770) 996-1200
(770) 907-2334
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
044077
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300020659A
—
GA
Enumeration date
12/13/2006
Last updated
11/09/2012
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