Provider Demographics
NPI:1205607801
Name:CPMOBGYN
Entity type:Organization
Organization Name:CPMOBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:404-754-1068
Mailing Address - Street 1:5810 BARK CAMP RD
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30564-1829
Mailing Address - Country:US
Mailing Address - Phone:404-754-1068
Mailing Address - Fax:
Practice Address - Street 1:1628 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7927
Practice Address - Country:US
Practice Address - Phone:770-888-3102
Practice Address - Fax:470-297-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service