Provider Demographics
NPI:1437554847
Name:SOUTHERN CRESCENT WOMEN'S HEALTH SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHERN CRESCENT WOMEN'S HEALTH SPECIALISTS
Other - Org Name:WOMEN'S HEALTH SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-474-0064
Mailing Address - Street 1:115 EAGLE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6486
Mailing Address - Country:US
Mailing Address - Phone:770-474-0064
Mailing Address - Fax:770-474-2998
Practice Address - Street 1:115 EAGLE SPRIGN DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281
Practice Address - Country:US
Practice Address - Phone:770-474-0064
Practice Address - Fax:770-474-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67788207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1689836892OtherNPI