Provider Demographics
NPI:1639114556
Name:PERIMETER OB/GYN CARE, LLC
Entity Type:Organization
Organization Name:PERIMETER OB/GYN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-396-2496
Mailing Address - Street 1:3025 BRECKINRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4979
Mailing Address - Country:US
Mailing Address - Phone:678-226-0082
Mailing Address - Fax:
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6932
Practice Address - Country:US
Practice Address - Phone:770-396-3496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040187207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2071Medicare PIN