Provider Demographics
NPI:1760605471
Name:CAMDEN OBGYN
Entity Type:Organization
Organization Name:CAMDEN OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKACS DI LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-673-1771
Mailing Address - Street 1:202 LAKESHORE DR
Mailing Address - Street 2:STE A
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3809
Mailing Address - Country:US
Mailing Address - Phone:912-673-1771
Mailing Address - Fax:912-673-1811
Practice Address - Street 1:202 LAKESHORE DR
Practice Address - Street 2:STE A
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3809
Practice Address - Country:US
Practice Address - Phone:912-673-1771
Practice Address - Fax:912-673-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH15604Medicare UPIN