Provider Demographics
NPI:1124393673
Name:WOMEN'S HEALTH OF MACON, LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH OF MACON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-744-0010
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4048
Mailing Address - Country:US
Mailing Address - Phone:478-744-0010
Mailing Address - Fax:478-744-0090
Practice Address - Street 1:1062 FORSYTH ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8631
Practice Address - Country:US
Practice Address - Phone:478-744-0010
Practice Address - Fax:478-744-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty