NPIMap

Organization Active NPI

Peachtree City Obstetrics and Gynecology, P.C.

  • Obstetrics & Gynecology Physician
  • Peachtree City, GA
National Provider Identifier
1447340401
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
PEACHTREE CITY OBSTETRICS AND GYNECOLOGY, P.C.
Practice address
210 Clover Reach
Peachtree City, GA 30269-1657
Phone
(770) 487-9604
Fax
(770) 631-0540
NPI assigned
Oct 13, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rebecca Banks, M.D.NPI 1033208475
Title
President
Phone
(770) 487-9604

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

210 Clover Reach
Peachtree City, GA 30269-1657

Mailing address

210 Clover Reach
P.O. Box 2505
Peachtree City, GA 30269-1657
Phone (770) 487-9604

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040428000346 GA Part B Supplier - Clinic/Group Practice 0749277143 Receives reassigned benefits from 3 practitioners
Practice locations: Newnan, GA; Peachtree City, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0257955Peachtree City Obstetrics and Gynecology PC210 Clover Reach, Peachtree City, GA 30269Provider-performed microscopyDec 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peachtree City OBGYN2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

775 Poplar Rd
Ste 360
Newnan, GA 30265
Phone (770) 487-9604

210 Clover Reach
Peachtree Cty, GA 30269
Phone (770) 487-9604

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447340401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 CLOVER REACH",
            "address_2": "P.O. BOX 2505",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691657",
            "telephone_number": "770-487-9604",
            "fax_number": "770-631-0540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 CLOVER REACH",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302691657",
            "telephone_number": "770-487-9604",
            "fax_number": "770-631-0540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACHTREE CITY OBSTETRICS AND GYNECOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANKS",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-487-9604",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree City, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.