EXECUTIVE OB-GYN, PC
Agencies at Goldenwood Ct, Powder Springs, GA

License number
Georgia R59280
Category
Agencies
Type
Nursing Care
Owner
Name: MS. DEBRA TOLLEY WHELAN M.S.N., C.N.M.
Title: PRESIDENT
Phone: (770) 795-0850
Address
Address
635 Goldenwood Ct, Powder Springs, GA 30127
National Provider ID: 1407023005
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EXECUTIVE OB-GYN, PC

635 Goldenwood Ct, Powder Springs, GA 30127

Status:
Inactive
Registration:
Apr 2, 2004
Inactive since:
Sep 6, 2010
State ID:
0421858
Business type:
Domestic Professional Corporation
CEO:
Tolley Debra Whelan (CEO), 635 Goldenwood Ct, Powder Springs, GA 30127 (Physical)
Agent:
Debra Whelan,635 Goldenwood Ct, Powder Springs, GA 30127 (Physical)

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