Provider Demographics
NPI:1821154758
Name:ATLANTA WOMEN'S HEALTH GROUP, P.C.
Entity Type:Organization
Organization Name:ATLANTA WOMEN'S HEALTH GROUP, P.C.
Other - Org Name:ATHENS OBSTETRICS AND GYNECOLOGY P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-548-4272
Mailing Address - Street 1:740 PRINCE AVE
Mailing Address - Street 2:BLDG 3
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5908
Mailing Address - Country:US
Mailing Address - Phone:706-548-4272
Mailing Address - Fax:706-548-9181
Practice Address - Street 1:740 PRINCE AVE
Practice Address - Street 2:BLDG 3
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5908
Practice Address - Country:US
Practice Address - Phone:706-548-4272
Practice Address - Fax:706-548-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3569OtherPTAN