Provider Demographics
NPI:1477627743
Name:CHATTAHOOCHEE GYNECOLOGY PC
Entity Type:Organization
Organization Name:CHATTAHOOCHEE GYNECOLOGY PC
Other - Org Name:CHATTAHOOCHE OBGYN PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TSAKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-813-8742
Mailing Address - Street 1:6610 MCGINNIS FERRY ROAD SUITE 100
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-813-8742
Mailing Address - Fax:770-813-1776
Practice Address - Street 1:6610 MCGINNIS FERRY ROAD SUITE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-813-8742
Practice Address - Fax:770-813-1776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31141207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31110Medicare UPIN
GA16BDDTPMedicare ID - Type Unspecified