Provider Demographics
NPI:1558559732
Name:PREMIER OBGYN, INC.
Entity Type:Organization
Organization Name:PREMIER OBGYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-878-4830
Mailing Address - Street 1:317 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2303
Mailing Address - Country:US
Mailing Address - Phone:229-878-4830
Mailing Address - Fax:229-878-5141
Practice Address - Street 1:317 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2303
Practice Address - Country:US
Practice Address - Phone:229-878-4830
Practice Address - Fax:229-878-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP7195Medicare PIN
GAI17105Medicare UPIN
GAH75688Medicare UPIN