Organization
MATERNAL GYNERATIONS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE J WIIST (VICE PRESIDENT)
(770) 513-4000
Entity
Organization
Contact information
Practice address
761 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4317
(770) 513-4000
(770) 995-3495
Mailing address
761 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4317
(770) 513-4000
(770) 995-3495
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ3628
PALMETTO GBA RAILROAD
GA
Enumeration date
01/31/2007
Last updated
12/16/2011
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