Provider Demographics
NPI:1073709432
Name:ST. MARYS OBSTETRICS & GYNECOLOGY, P. C.
Entity Type:Organization
Organization Name:ST. MARYS OBSTETRICS & GYNECOLOGY, P. C.
Other - Org Name:ST. MARYS OB/GYN, P. C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAREED
Authorized Official - Middle Name:Z
Authorized Official - Last Name:KADUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-729-6600
Mailing Address - Street 1:203 LAKESHORE PT
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3843
Mailing Address - Country:US
Mailing Address - Phone:912-729-6600
Mailing Address - Fax:912-729-6616
Practice Address - Street 1:203 LAKESHORE PT
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3843
Practice Address - Country:US
Practice Address - Phone:912-729-6600
Practice Address - Fax:912-729-6616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA022993207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty