Provider Demographics
NPI:1700131836
Name:ATLANTA PREMIER OB/GYN ASSOCIATES, PC
Entity Type:Organization
Organization Name:ATLANTA PREMIER OB/GYN ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-705-4900
Mailing Address - Street 1:764 MEMORIAL DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-1573
Mailing Address - Country:US
Mailing Address - Phone:678-705-4900
Mailing Address - Fax:678-705-5441
Practice Address - Street 1:764 MEMORIAL DR SE STE 101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-1573
Practice Address - Country:US
Practice Address - Phone:678-705-4900
Practice Address - Fax:678-705-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064644261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100100AMedicaid