Provider Demographics
NPI:1891903894
Name:METRO ATLANTA WOMENS HEALTH SPECIALIST
Entity Type:Organization
Organization Name:METRO ATLANTA WOMENS HEALTH SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-508-8133
Mailing Address - Street 1:5462 MEMORIAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3239
Mailing Address - Country:US
Mailing Address - Phone:404-508-8133
Mailing Address - Fax:404-508-8450
Practice Address - Street 1:5462 MEMORIAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3239
Practice Address - Country:US
Practice Address - Phone:404-508-8133
Practice Address - Fax:404-508-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL032282174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCRSMedicare ID - Type Unspecified
GAF08359Medicare UPIN