Provider Demographics
NPI:1649397175
Name:MIDDLE GEORGIA WOMEN'S SPECIALISTS, INC.
Entity Type:Organization
Organization Name:MIDDLE GEORGIA WOMEN'S SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-274-1040
Mailing Address - Street 1:105 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2501
Mailing Address - Country:US
Mailing Address - Phone:478-274-1040
Mailing Address - Fax:478-274-0075
Practice Address - Street 1:105 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2501
Practice Address - Country:US
Practice Address - Phone:478-274-1040
Practice Address - Fax:478-274-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000788026BMedicaid
GA000840287AMedicaid
GA000788026BMedicaid
GAG69337Medicare UPIN
GA=========OtherTAX ID # FOR PRACTICE
GAGRP3525Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER