Provider Demographics
NPI:1013407972
Name:OBGYNE BIRTH CENTER FOR NATURAL DELIVERIES
Entity Type:Organization
Organization Name:OBGYNE BIRTH CENTER FOR NATURAL DELIVERIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE TEAM
Authorized Official - Prefix:
Authorized Official - First Name:ARDRIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-745-3014
Mailing Address - Street 1:167 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-3239
Mailing Address - Country:US
Mailing Address - Phone:478-745-3014
Mailing Address - Fax:478-992-9786
Practice Address - Street 1:167 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-3239
Practice Address - Country:US
Practice Address - Phone:478-745-3014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003226256AMedicaid