Provider Demographics
NPI:1407027261
Name:CLINICA DE LA MUJER
Entity Type:Organization
Organization Name:CLINICA DE LA MUJER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:DAMIEN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-496-1592
Mailing Address - Street 1:3644 CHAMBLEE TUCKER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4405
Mailing Address - Country:US
Mailing Address - Phone:770-496-1592
Mailing Address - Fax:770-496-1577
Practice Address - Street 1:3644 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-4405
Practice Address - Country:US
Practice Address - Phone:770-496-1592
Practice Address - Fax:770-496-1577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022081207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty