Provider Demographics
NPI:1891864724
Name:EAST ATLANTA GYNECOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:EAST ATLANTA GYNECOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:LASHUNT
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA,FACOG,FICS
Authorized Official - Phone:770-593-8866
Mailing Address - Street 1:5900 HILLANDALE DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3802
Mailing Address - Country:US
Mailing Address - Phone:770-593-8866
Mailing Address - Fax:404-501-8270
Practice Address - Street 1:5900 HILLANDALE DR
Practice Address - Street 2:SUITE 255
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3802
Practice Address - Country:US
Practice Address - Phone:770-593-8866
Practice Address - Fax:404-501-8270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0341611207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0341611OtherSTATE LICENSE
GA00470874BMedicaid
GA16BDDQPMedicare ID - Type Unspecified
GAF11127Medicare UPIN