Provider Demographics
NPI:1942834411
Name:PREGNANCY RESOURCE CENTER OF GWINNETT
Entity Type:Organization
Organization Name:PREGNANCY RESOURCE CENTER OF GWINNETT
Other - Org Name:OBRIA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-338-1622
Mailing Address - Street 1:565 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-338-1680
Mailing Address - Fax:770-338-7329
Practice Address - Street 1:565 OLD NORCROSS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-338-1680
Practice Address - Fax:770-338-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health