Provider Demographics
NPI:1407840069
Name:DOUGLAS WOMENS CENTER PC
Entity Type:Organization
Organization Name:DOUGLAS WOMENS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-941-8662
Mailing Address - Street 1:880 CRESTMARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2646
Mailing Address - Country:US
Mailing Address - Phone:770-941-8662
Mailing Address - Fax:770-739-6006
Practice Address - Street 1:880 CRESTMARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2646
Practice Address - Country:US
Practice Address - Phone:770-941-8662
Practice Address - Fax:770-739-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207V00000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty