Provider Demographics
NPI:1609805548
Name:AMITY OBSTETRICS AND GYNECOLOGY ASSOC, P.A.
Entity Type:Organization
Organization Name:AMITY OBSTETRICS AND GYNECOLOGY ASSOC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-366-8400
Mailing Address - Street 1:330 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5055
Mailing Address - Country:US
Mailing Address - Phone:704-366-8400
Mailing Address - Fax:704-366-8499
Practice Address - Street 1:330 BILLINGSLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5055
Practice Address - Country:US
Practice Address - Phone:704-366-8400
Practice Address - Fax:704-366-8499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26269207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7903032Medicaid
NC2315207Medicare ID - Type Unspecified