Provider Demographics
NPI:1427563584
Name:DOURRON NORTHSIDE OB GYN LLC
Entity Type:Organization
Organization Name:DOURRON NORTHSIDE OB GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOURRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-294-0472
Mailing Address - Street 1:2675 NORTH DECATUR ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-294-0472
Mailing Address - Fax:
Practice Address - Street 1:2675 NORTH DECATUR ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-294-0472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048617207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty