Provider Demographics
NPI:1629048871
Name:THOMASVILLE OB-GYN ASSOCIATES, PA
Entity Type:Organization
Organization Name:THOMASVILLE OB-GYN ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:DORTON
Authorized Official - Suffix:X
Authorized Official - Credentials:MD
Authorized Official - Phone:336-475-6139
Mailing Address - Street 1:1302 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-3419
Mailing Address - Country:US
Mailing Address - Phone:336-475-6139
Mailing Address - Fax:336-475-3331
Practice Address - Street 1:1302 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3419
Practice Address - Country:US
Practice Address - Phone:336-475-6139
Practice Address - Fax:336-475-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39470207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902827Medicaid
NC8902827Medicaid