Provider Demographics
NPI:1033472725
Name:ATLANTA WEST GYNECOLOGY PC
Entity Type:Organization
Organization Name:ATLANTA WEST GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-732-2959
Mailing Address - Street 1:939 BOB ARNOLD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3258
Mailing Address - Country:US
Mailing Address - Phone:770-732-2959
Mailing Address - Fax:770-732-2947
Practice Address - Street 1:939 BOB ARNOLD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3258
Practice Address - Country:US
Practice Address - Phone:770-732-2959
Practice Address - Fax:770-732-2947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035462207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty