Provider Demographics
NPI:1033715974
Name:GYN ATLANTA, PC
Entity Type:Organization
Organization Name:GYN ATLANTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BOVERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-250-3600
Mailing Address - Street 1:1067 STOVALL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1220
Mailing Address - Country:US
Mailing Address - Phone:404-312-1047
Mailing Address - Fax:404-481-2176
Practice Address - Street 1:5430 GLENRIDGE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1342
Practice Address - Country:US
Practice Address - Phone:404-250-3600
Practice Address - Fax:404-381-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000622949EMedicaid