Basic Information
Provider Information
NPI: 1205472362
EntityType: 2
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OrganizationName: ADVANCED GYNECOLOGY PC
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Mailing Information
Address1: 1561 JANMAR RD
Address2:  
City: SNELLVILLE
State: GA
PostalCode: 300785639
CountryCode: US
TelephoneNumber: 6783448900
FaxNumber: 6786665201
Practice Location
Address1: 1800 PEACHTREE ST NW STE 660
Address2:  
City: ATLANTA
State: GA
PostalCode: 303092522
CountryCode: US
TelephoneNumber: 6783448900
FaxNumber: 6786665201
Other Information
ProviderEnumerationDate: 11/25/2019
LastUpdateDate: 11/25/2019
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AuthorizedOfficialLastName: RAYBON
AuthorizedOfficialFirstName: ROBERT
AuthorizedOfficialMiddleName: BRIAN
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 7062827676
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IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VF0040X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery

No ID Information.


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