Provider Demographics
NPI:1417254335
Name:HERITAGE OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:HERITAGE OBSTETRICS & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-531-1515
Mailing Address - Street 1:688 LANIER PARK DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30505-0000
Mailing Address - Country:US
Mailing Address - Phone:770-531-1515
Mailing Address - Fax:770-535-1930
Practice Address - Street 1:5875 THOMPSON MILL RD
Practice Address - Street 2:STE 140
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-4133
Practice Address - Country:US
Practice Address - Phone:770-531-1515
Practice Address - Fax:770-531-1930
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE OBSTETRICS & GYNECOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty