Provider Demographics
NPI:1689728685
Name:ATLANTA WOMEN'S MEDICAL CTR., INC
Entity Type:Organization
Organization Name:ATLANTA WOMEN'S MEDICAL CTR., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-346-3417
Mailing Address - Street 1:3890 REDWINE RD SW
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5509
Mailing Address - Country:US
Mailing Address - Phone:404-346-3417
Mailing Address - Fax:404-346-3418
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5509
Practice Address - Country:US
Practice Address - Phone:404-346-3417
Practice Address - Fax:404-346-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH50021Medicare UPIN