Provider Demographics
NPI:1629390133
Name:DOURRON WOMEN'S SPECIALIST
Entity Type:Organization
Organization Name:DOURRON WOMEN'S SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOURRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-381-1531
Mailing Address - Street 1:253 UPPER RIVERDALE RD SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4945
Mailing Address - Country:US
Mailing Address - Phone:678-381-1531
Mailing Address - Fax:678-990-3767
Practice Address - Street 1:253 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4945
Practice Address - Country:US
Practice Address - Phone:678-381-1531
Practice Address - Fax:678-990-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014308207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty