Provider Demographics
NPI:1790853489
Name:WOMEN'S CENTER OF ATHENS
Entity Type:Organization
Organization Name:WOMEN'S CENTER OF ATHENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-227-8999
Mailing Address - Street 1:1181 LANGFORD DR.
Mailing Address - Street 2:BLDG 300-101
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:706-227-8999
Mailing Address - Fax:706-227-6118
Practice Address - Street 1:1181 LANGFORD DR
Practice Address - Street 2:BLDG 300-101
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7242
Practice Address - Country:US
Practice Address - Phone:706-227-8999
Practice Address - Fax:706-227-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID