Provider Demographics
NPI:1477698710
Name:PREMIER WOMENS SPECIALIST LLC
Entity Type:Organization
Organization Name:PREMIER WOMENS SPECIALIST LLC
Other - Org Name:DR KEVIN DAUS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-296-1424
Mailing Address - Street 1:2675 N DECATUR RD STE 501
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6134
Mailing Address - Country:US
Mailing Address - Phone:404-296-1424
Mailing Address - Fax:404-501-7393
Practice Address - Street 1:2675 N DECATUR RD STE 501
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6134
Practice Address - Country:US
Practice Address - Phone:404-296-1424
Practice Address - Fax:404-501-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26626207V00000X
GA028394207V00000X
AL12125207V00000X
GA02839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477698710OtherNPI
GA0004060095AMedicaid
GA000406095AMedicaid
GAP00345500OtherRR MEDICARE
GA118352OtherBCBS
GAP00345500OtherRR MEDICARE
GA16BDBQPMedicare ID - Type Unspecified