Mt Vernon OB/GYN, LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

019640 Issued in GA

Legal business name

MT VERNON OB/GYN, LLC

Practice address

755 Mount Vernon Hwy NE
#330
Atlanta, GA 30328-4274

Phone

(404) 256-2277

NPI assigned

Jul 5, 2006

Organization subpart

No

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

Authorized official

Name

Stephen C Blank, MD

Title

Owner

Phone

(404) 256-2277

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1811928054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3025 BRECKINRIDGE BLVD",
            "address_2": "SUITE 120",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300967611",
            "telephone_number": "678-226-0082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 MOUNT VERNON HWY NE",
            "address_2": "#330",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303284274",
            "telephone_number": "404-256-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT VERNON OB/GYN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "BLANK",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-256-2277",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "019640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.