Provider Demographics
NPI:1104856392
Name:NORTH PARK OB/GYN ASSOC, PC
Entity Type:Organization
Organization Name:NORTH PARK OB/GYN ASSOC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-4549
Mailing Address - Street 1:2051 HAMILL RD # A
Mailing Address - Street 2:#400
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4026
Mailing Address - Country:US
Mailing Address - Phone:423-877-4549
Mailing Address - Fax:423-875-8510
Practice Address - Street 1:2051 HAMILL RD # A
Practice Address - Street 2:#400
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4026
Practice Address - Country:US
Practice Address - Phone:423-877-4549
Practice Address - Fax:423-875-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374911Medicare ID - Type Unspecified