Provider Demographics
NPI:1619000312
Name:WOMENS HEALTHCARE AND AESTHETICS
Entity Type:Organization
Organization Name:WOMENS HEALTHCARE AND AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-760-8484
Mailing Address - Street 1:1403 MANCHESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3879
Mailing Address - Country:US
Mailing Address - Phone:770-760-8484
Mailing Address - Fax:770-760-7664
Practice Address - Street 1:5910 HILLANDALE DR STE 201
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-1878
Practice Address - Country:US
Practice Address - Phone:770-760-8484
Practice Address - Fax:770-760-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA393403OtherBC BS
GAF75585Medicare UPIN
GA16BBCSMMedicare ID - Type Unspecified