Provider Demographics
NPI:1235489485
Name:CENTRAL ALBANY OB-GYN, P.C.
Entity Type:Organization
Organization Name:CENTRAL ALBANY OB-GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-435-0002
Mailing Address - Street 1:421 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1973
Mailing Address - Country:US
Mailing Address - Phone:229-435-0002
Mailing Address - Fax:229-883-1782
Practice Address - Street 1:421 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1973
Practice Address - Country:US
Practice Address - Phone:229-435-0002
Practice Address - Fax:229-883-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058965207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty