| NPI | 1669602280 |
|---|---|
| Doing Business As | PROVIDENT OB/GYN ASSOCIATES |
| Entity Type | Organization |
| Authorized Contact | ROBIN J MADDOX Provider Enrollment Coordinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2011-06-01 |