Provider Demographics
NPI:1679515050
Name:WINYAH WOMEN'S CENTER, LLC
Entity Type:Organization
Organization Name:WINYAH WOMEN'S CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-546-3132
Mailing Address - Street 1:1306 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-2800
Mailing Address - Country:US
Mailing Address - Phone:843-546-3132
Mailing Address - Fax:843-546-2268
Practice Address - Street 1:1306 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2800
Practice Address - Country:US
Practice Address - Phone:843-546-3132
Practice Address - Fax:843-546-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1731Medicaid