Organization
OGEECHEE OB-GYN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONYA K CLARK (PRACTICE MANAGER)
(912) 871-6206
Entity
Organization
Contact information
Practice address
1310 BRAMPTON AVE, STATESBORO, GA 30458-0851
(912) 871-6206
(912) 681-8558
Mailing address
1310 BRAMPTON AVE, STATESBORO, GA 30458-0851
(912) 871-6206
(912) 681-8558
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
010585
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000087194A
—
GA
01
—
004021
LICENSE
GA
01
—
010585
LICENSE
GA
01
—
1811966369
NPI
GA
01
—
72690
LICENSE
GA
01
—
80249
LICENSE
GA
01
—
CNM230942
LICENSE
GA
01
—
RN144963NP
LICENSE
GA
01
—
RN150025NP
LICENSE
GA
01
—
RN184063NP
LICENSE
GA
01
—
RN230942NP
LICENSE
GA
Enumeration date
03/16/2006
Last updated
01/15/2026
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