Provider Demographics
NPI:1801007695
Name:EAST GEORGIA WOMENS CENTER
Entity Type:Organization
Organization Name:EAST GEORGIA WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & BILLING
Authorized Official - Prefix:
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-871-4800
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-0428
Mailing Address - Country:US
Mailing Address - Phone:912-871-4800
Mailing Address - Fax:912-871-4900
Practice Address - Street 1:1012 BERMUDA RUN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:912-871-4800
Practice Address - Fax:912-871-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03658207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3829Medicare ID - Type UnspecifiedMEDICARE GROUP ID