Provider Demographics
NPI:1750663118
Name:SOUTHEASTERN GYNECOLOGIC ONCOLOGY AT SAINT JOSEPH'S, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN GYNECOLOGIC ONCOLOGY AT SAINT JOSEPH'S, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-843-6409
Mailing Address - Street 1:980 JOHNSON FERRY ROAD,
Mailing Address - Street 2:SUITE 900
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1609
Mailing Address - Country:US
Mailing Address - Phone:678-420-4100
Mailing Address - Fax:678-420-4111
Practice Address - Street 1:980 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 900
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1609
Practice Address - Country:US
Practice Address - Phone:678-420-4100
Practice Address - Fax:678-420-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty