Provider Demographics
NPI:1922273655
Name:CENTER FOR WOMEN'S HEALTH AND FITNESS, LLC
Entity Type:Organization
Organization Name:CENTER FOR WOMEN'S HEALTH AND FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-369-1200
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30086-1390
Mailing Address - Country:US
Mailing Address - Phone:706-369-1200
Mailing Address - Fax:
Practice Address - Street 1:965 HAWTHORNE AVE
Practice Address - Street 2:100A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2139
Practice Address - Country:US
Practice Address - Phone:706-369-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7494Medicare PIN