Provider Demographics
NPI:1043357023
Name:GREENVILLE WOMENS WELLNESS CENTER
Entity Type:Organization
Organization Name:GREENVILLE WOMENS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-455-9582
Mailing Address - Street 1:4221 RIDGECREST RD STE 109
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-6015
Mailing Address - Country:US
Mailing Address - Phone:903-455-9582
Mailing Address - Fax:903-455-5689
Practice Address - Street 1:4221 RIDGECREST RD STE 109
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-6015
Practice Address - Country:US
Practice Address - Phone:903-455-9582
Practice Address - Fax:903-455-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty