Provider Demographics
NPI:1730564709
Name:DEKALB OBGYN AFFILIATES LLC
Entity type:Organization
Organization Name:DEKALB OBGYN AFFILIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGAUD-ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-226-1601
Mailing Address - Street 1:4480 N SHALLOWFORD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6410
Mailing Address - Country:US
Mailing Address - Phone:470-226-1601
Mailing Address - Fax:470-225-6345
Practice Address - Street 1:4480 N SHALLOWFORD RD STE 200
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6410
Practice Address - Country:US
Practice Address - Phone:470-226-1601
Practice Address - Fax:470-225-6345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05869207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty