Provider Demographics
NPI:1225253842
Name:WOMENS SPECIALTY CENTER OF NORTH GEORGIA
Entity Type:Organization
Organization Name:WOMENS SPECIALTY CENTER OF NORTH GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOLINARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-692-3539
Mailing Address - Street 1:220 J L WHITE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4893
Mailing Address - Country:US
Mailing Address - Phone:706-692-3539
Mailing Address - Fax:706-692-9364
Practice Address - Street 1:220 J L WHITE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4893
Practice Address - Country:US
Practice Address - Phone:706-692-3539
Practice Address - Fax:706-692-9364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053200207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00221592GMedicaid
GAD30276Medicare UPIN
GA00221592GMedicaid
GAGRP3056Medicare ID - Type Unspecified