Provider Demographics
NPI:1649757907
Name:ATLANTA MIDTOWN GYNECOLOGY 2 LLC
Entity Type:Organization
Organization Name:ATLANTA MIDTOWN GYNECOLOGY 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER RELATIONS LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-579-2626
Mailing Address - Street 1:PO BOX 468329
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31146-8329
Mailing Address - Country:US
Mailing Address - Phone:404-943-0205
Mailing Address - Fax:404-943-0209
Practice Address - Street 1:842 N HIGHLAND AVE NE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4514
Practice Address - Country:US
Practice Address - Phone:404-685-8867
Practice Address - Fax:404-685-8137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty