Provider Demographics
NPI:1326220567
Name:NORTH FULTON OB-GYN, P.C.
Entity Type:Organization
Organization Name:NORTH FULTON OB-GYN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINOKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-754-4445
Mailing Address - Street 1:3400 OLD MILTON PKWY
Mailing Address - Street 2:SUITE C585
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-754-4445
Mailing Address - Fax:770-754-4449
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:SUITE C585
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-754-4445
Practice Address - Fax:770-754-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00620958BMedicaid