Provider Demographics
NPI:1285844498
Name:SOUTHERN CENTER FOR WOMENS HEALTH PC
Entity Type:Organization
Organization Name:SOUTHERN CENTER FOR WOMENS HEALTH PC
Other - Org Name:THE WOMENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-845-0500
Mailing Address - Street 1:310 S LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3144
Mailing Address - Country:US
Mailing Address - Phone:706-845-0500
Mailing Address - Fax:706-812-9315
Practice Address - Street 1:310 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3144
Practice Address - Country:US
Practice Address - Phone:706-845-0500
Practice Address - Fax:706-812-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043546174400000X
207V00000X, 207VE0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000773924AMedicaid
GA16BDSSRMedicare ID - Type Unspecified
GA000773924AMedicaid