Provider Demographics
NPI:1871654624
Name:THE WOMENS CENTER PC
Entity Type:Organization
Organization Name:THE WOMENS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-413-4644
Mailing Address - Street 1:2750 OWENS RD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3991
Mailing Address - Country:US
Mailing Address - Phone:678-413-4644
Mailing Address - Fax:678-413-4624
Practice Address - Street 1:2750 OWENS RD SW
Practice Address - Street 2:SUITE A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3991
Practice Address - Country:US
Practice Address - Phone:678-413-4644
Practice Address - Fax:678-413-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049382207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADB5807OtherMEDICARE ID TYPE UNSPECIFIED
GAGRP6104Medicare PIN