Provider Demographics
NPI:1659482883
Name:DEKALB-GWINNETT OB/GYN PC
Entity Type:Organization
Organization Name:DEKALB-GWINNETT OB/GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-449-8171
Mailing Address - Street 1:4045 WETHERBURN WAY
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1893
Mailing Address - Country:US
Mailing Address - Phone:770-449-8171
Mailing Address - Fax:770-449-5015
Practice Address - Street 1:4045 WETHERBURN WAY
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1893
Practice Address - Country:US
Practice Address - Phone:770-449-8171
Practice Address - Fax:770-449-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty