Provider Demographics
NPI:1366576100
Name:GREATER ATLANTA OBGYN ASSOCIATES
Entity type:Organization
Organization Name:GREATER ATLANTA OBGYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-PYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VELVET
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-964-4142
Mailing Address - Street 1:6285 SHANNON PKWY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2081
Mailing Address - Country:US
Mailing Address - Phone:770-964-4142
Mailing Address - Fax:770-964-4575
Practice Address - Street 1:6285 SHANNON PKWY
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2081
Practice Address - Country:US
Practice Address - Phone:770-964-4142
Practice Address - Fax:770-964-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036819207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BDDGGMedicare ID - Type Unspecified
GAF67595Medicare UPIN