Provider Demographics
NPI:1265568166
Name:DUNWOODY OBSTETRICS & GYNECOLOGY, PC
Entity type:Organization
Organization Name:DUNWOODY OBSTETRICS & GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:A.
Authorized Official - Middle Name:L
Authorized Official - Last Name:SERMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-551-9616
Mailing Address - Street 1:1829 INDEPENDENCE SQ
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5151
Mailing Address - Country:US
Mailing Address - Phone:770-551-9616
Mailing Address - Fax:770-394-3647
Practice Address - Street 1:1829 INDEPENDENCE SQ
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5151
Practice Address - Country:US
Practice Address - Phone:770-551-9616
Practice Address - Fax:770-394-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026933207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty