Provider Demographics
NPI:1760725162
Name:ADVANCED OB GYN CARE OF WARNER ROBINS, LLC
Entity Type:Organization
Organization Name:ADVANCED OB GYN CARE OF WARNER ROBINS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-923-6462
Mailing Address - Street 1:1570 WATSON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3432
Mailing Address - Country:US
Mailing Address - Phone:478-923-6462
Mailing Address - Fax:478-225-1271
Practice Address - Street 1:1570 WATSON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3432
Practice Address - Country:US
Practice Address - Phone:478-923-6462
Practice Address - Fax:478-225-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052550207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA299296634FMedicaid
GA299296634FMedicaid
GAH53023Medicare UPIN