Provider Demographics
NPI:1447587910
Name:MERIDIAN OBSTETRICS AND GYNECOLOGY PC
Entity Type:Organization
Organization Name:MERIDIAN OBSTETRICS AND GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALISIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-250-3660
Mailing Address - Street 1:PO BOX 922937
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-2937
Mailing Address - Country:US
Mailing Address - Phone:404-250-3660
Mailing Address - Fax:404-250-3665
Practice Address - Street 1:755 MOUNT VERNON HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4274
Practice Address - Country:US
Practice Address - Phone:404-250-3660
Practice Address - Fax:404-250-3665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000819959BMedicaid
GAG98355Medicare UPIN