Organization
MODERN OBSTETRICS AND GYNECOLOGY OF NORTH ATLANTA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
INGRID VIVIAN REYES M.D. (SECRETARY)
(404) 446-2496
Entity
Organization
Contact information
Practice address
10692 MEDLOCK BRIDGE RD, SUITE 100A, JOHNS CREEK, GA 30097-1890
(404) 446-2496
Mailing address
10692 MEDLOCK BRIDGE RD, SUITE 100A, JOHNS CREEK, GA 30097-1890
(404) 446-2496
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
064060
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1019123110002
—
PA
Enumeration date
07/12/2010
Last updated
09/23/2016
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