Provider Demographics
NPI:1790987436
Name:OB GYN WOMEN SPECIALIST OF GA
Entity Type:Organization
Organization Name:OB GYN WOMEN SPECIALIST OF GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VINTONNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-284-5498
Mailing Address - Street 1:3951 SNAPFINGER PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3203
Mailing Address - Country:US
Mailing Address - Phone:404-284-5498
Mailing Address - Fax:404-284-3855
Practice Address - Street 1:3951 SNAPFINGER PKWY STE 350
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3203
Practice Address - Country:US
Practice Address - Phone:404-284-5498
Practice Address - Fax:404-284-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31482174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDBVTMedicare ID - Type Unspecified
GAE81784Medicare UPIN