Organization
MPPG, INC.
Active
Other names
Provident OB/GYN Associates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN J MADDOX (PROVIDER ENROLLMENT COORDINATOR)
(912) 350-9335
Entity
Organization
Contact information
Practice address
1004 MEMORIAL LN, SUITE 500, SAVANNAH, GA 31410-1254
(912) 897-4604
(912) 897-4608
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(912) 897-4604
(912) 897-4608
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
07/16/2009
Last updated
06/01/2011
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