Provider Demographics
NPI:1619333713
Name:ST. THERESA'S OB/GYN INC.
Entity Type:Organization
Organization Name:ST. THERESA'S OB/GYN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANYAKWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-545-5551
Mailing Address - Street 1:2311 HENRY CLOWER BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7418
Mailing Address - Country:US
Mailing Address - Phone:470-545-5551
Mailing Address - Fax:470-545-9031
Practice Address - Street 1:2311 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7418
Practice Address - Country:US
Practice Address - Phone:470-545-5551
Practice Address - Fax:470-545-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty