Provider Demographics
NPI:1639372907
Name:SYLACAUGA OBSTETRICS AND GYNECOLOGY, PC
Entity Type:Organization
Organization Name:SYLACAUGA OBSTETRICS AND GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:REHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-249-6995
Mailing Address - Street 1:315 W FORT WILLIAMS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2433
Mailing Address - Country:US
Mailing Address - Phone:256-249-6995
Mailing Address - Fax:256-245-6992
Practice Address - Street 1:315 W FORT WILLIAMS ST STE 100
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2433
Practice Address - Country:US
Practice Address - Phone:256-249-6995
Practice Address - Fax:256-245-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28010207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529932834Medicaid