Provider Demographics
NPI:1316193667
Name:GENESIS WOMEN'S CARE LLC
Entity Type:Organization
Organization Name:GENESIS WOMEN'S CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-629-7380
Mailing Address - Street 1:PO BOX 2105
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-2105
Mailing Address - Country:US
Mailing Address - Phone:706-629-7380
Mailing Address - Fax:706-629-5406
Practice Address - Street 1:190 CURTIS PKWY NE
Practice Address - Street 2:SUITE B
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2057
Practice Address - Country:US
Practice Address - Phone:706-629-7380
Practice Address - Fax:706-629-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051437207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty