Provider Demographics
NPI:1760445712
Name:FAIRBROTHER, GENEVIEVE L (MD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:L
Last Name:FAIRBROTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:3890 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1284
Practice Address - Country:US
Practice Address - Phone:678-775-2300
Practice Address - Fax:678-775-2359
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037531174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000720486KMedicaid
GA000720486LMedicaid
GA000720486JMedicaid
GA000720486MMedicaid