Provider Demographics
NPI:1033631809
Name:GRIFFIN OB/GYN CLINIC II, LLC
Entity Type:Organization
Organization Name:GRIFFIN OB/GYN CLINIC II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER RELATIONS LIAISON
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-579-2626
Mailing Address - Street 1:PO BOX 468329
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31146-8329
Mailing Address - Country:US
Mailing Address - Phone:404-943-0205
Mailing Address - Fax:404-943-0209
Practice Address - Street 1:503 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4211
Practice Address - Country:US
Practice Address - Phone:770-467-0614
Practice Address - Fax:770-412-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty