| NPI | 1982925145 |
|---|---|
| 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 |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2011-06-01 |