Provider Demographics
NPI:1407089816
Name:MERIDIAN WOMEN'S HEALTHCARE
Entity Type:Organization
Organization Name:MERIDIAN WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-551-9616
Mailing Address - Street 1:1829 INDEPENDENCE SQ
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5153
Mailing Address - Country:US
Mailing Address - Phone:770-551-9616
Mailing Address - Fax:770-396-3647
Practice Address - Street 1:7823 KIVERTON PL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-5889
Practice Address - Country:US
Practice Address - Phone:770-551-9616
Practice Address - Fax:770-396-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041823207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000935217CMedicaid