Provider Demographics
NPI:1467683342
Name:GYN & OB OF DEKALB, P.C.
Entity Type:Organization
Organization Name:GYN & OB OF DEKALB, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-299-9307
Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-299-9307
Mailing Address - Fax:404-299-9309
Practice Address - Street 1:1805 PARKE PLAZA CIR
Practice Address - Street 2:SUITE 102
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3637
Practice Address - Country:US
Practice Address - Phone:770-469-9961
Practice Address - Fax:770-413-0030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GYN & OB OF DEKALB, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty