Basic Information
| Provider Information | |||||||||
| NPI: | 1114115847 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW MILLENNIUM OBSETRICS & GYNECOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 83 UPPER RIVERDALE RD SW BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302742636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709910778 | ||||||||
| FaxNumber: | 7709917390 | ||||||||
| Practice Location | |||||||||
| Address1: | 83 UPPER RIVERDALE RD SW BLDG 2 | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302742636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709910778 | ||||||||
| FaxNumber: | 7709917390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7709910778 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | 32110 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.