NPIMap

Organization Active NPI

St. Theresa's OB/GYN Inc.

  • Obstetrics & Gynecology Physician
  • Snellville, GA
National Provider Identifier
1619333713
Registry record updated Jan 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ST. THERESA'S OB/GYN INC.
Practice address
2311 Henry Clower Blvd
Suite E
Snellville, GA 30078-7418
Phone
(470) 545-5551
Fax
(470) 545-9031
NPI assigned
Jan 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2016

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

Authorized official

Name
Anthony Anyakwo
Title
Office Manager
Phone
(470) 545-5551

Specialties & licenses 1

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

Addresses

Primary practice location

2311 Henry Clower Blvd
Suite E
Snellville, GA 30078-7418

Mailing address

2311 Henry Clower Blvd
Suite E
Snellville, GA 30078-7418
Phone (470) 545-5551

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160502000572 GA Part B Supplier - Clinic/Group Practice 3971802646 Receives reassigned benefits from 2 practitioners
Practice locations: Snellville, GA

National Provider Directory

National Provider Directory

Locations

2311 Henry Clower Blvd
Ste E
Snellville, GA 30078
Phone (470) 545-5551

Practitioners & affiliated clinicians

Practitioners 7

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": "1452038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452038400000",
    "number": "1619333713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 HENRY CLOWER BLVD",
            "address_2": "SUITE E",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787418",
            "telephone_number": "470-545-5551",
            "fax_number": "470-545-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 HENRY CLOWER BLVD",
            "address_2": "SUITE E",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300787418",
            "telephone_number": "470-545-5551",
            "fax_number": "470-545-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. THERESA'S OB/GYN INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-06",
        "last_updated": "2016-01-06",
        "status": "A",
        "authorized_official_last_name": "ANYAKWO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "470-545-5551"
    },
    "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 Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.