Provider Demographics
NPI:1619201944
Name:SOUTHEAST WOMEN'S CENTER, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST WOMEN'S CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JABLONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-4040
Mailing Address - Street 1:300 S 3RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4575
Mailing Address - Country:US
Mailing Address - Phone:919-938-4040
Mailing Address - Fax:919-938-4075
Practice Address - Street 1:2076 HWY 42 WEST
Practice Address - Street 2:SUITE 250
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9226
Practice Address - Country:US
Practice Address - Phone:919-550-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015W1Medicaid
NC2335639Medicare PIN