Provider Demographics
NPI:1396813317
Name:WOMENS HEALTH PC
Entity Type:Organization
Organization Name:WOMENS HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PC/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:478-374-9935
Mailing Address - Street 1:821 PLAZA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023
Mailing Address - Country:US
Mailing Address - Phone:478-374-9935
Mailing Address - Fax:478-374-7442
Practice Address - Street 1:821 PLAZA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023
Practice Address - Country:US
Practice Address - Phone:478-374-9935
Practice Address - Fax:478-374-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000502312AMedicaid
GA16BDCSDMedicare ID - Type Unspecified
GA000502312AMedicaid