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
14 OKATIE CENTER BLVD. SOUTH, SUITE 101, OKATIE, SC 29909
(843) 836-3800
(843) 705-3828
Mailing address
PO BOX 102032, ATLANTA, GA 30368-2032
(843) 836-3800
(843) 705-3828
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
06/22/2010
Last updated
06/01/2011
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