Provider Demographics
NPI:1801924865
Name:OB-GYN, INC
Entity type:Organization
Organization Name:OB-GYN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:IKE
Authorized Official - Last Name:OJUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-507-4842
Mailing Address - Street 1:1018 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7384
Mailing Address - Country:US
Mailing Address - Phone:770-507-4842
Mailing Address - Fax:770-507-6964
Practice Address - Street 1:1018 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7384
Practice Address - Country:US
Practice Address - Phone:770-507-4842
Practice Address - Fax:770-507-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA121101876AMedicaid
GAG60860Medicare UPIN
GA16BBCFLMedicare ID - Type Unspecified