Provider Demographics
NPI:1952321457
Name:AZALEA WOMEN'S HEALTHCARE, PA
Entity Type:Organization
Organization Name:AZALEA WOMEN'S HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:PHILOMENIA
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-877-5767
Mailing Address - Street 1:1219 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4611
Mailing Address - Country:US
Mailing Address - Phone:850-877-5767
Mailing Address - Fax:850-877-5055
Practice Address - Street 1:1219 HODGES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4611
Practice Address - Country:US
Practice Address - Phone:850-877-5767
Practice Address - Fax:850-877-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002753400Medicaid
FL94879OtherBLUE CROSS BLUE SHIELD
FLK3885Medicare PIN