Provider Demographics
NPI:1104197797
Name:LIFE CYCLE OB/GYN, LLC
Entity Type:Organization
Organization Name:LIFE CYCLE OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGOUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-766-8371
Mailing Address - Street 1:2739 FELTON DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3603
Mailing Address - Country:US
Mailing Address - Phone:404-766-8371
Mailing Address - Fax:404-767-3926
Practice Address - Street 1:3886 PRINCETON LAKES WAY SW
Practice Address - Street 2:SUITE 160
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5511
Practice Address - Country:US
Practice Address - Phone:404-530-3060
Practice Address - Fax:404-344-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045937207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty