Provider Demographics
NPI:1255545471
Name:PIEDMONT PREFERRED WOMEN'S HEALTHCARE ASSOCIATES INC.
Entity type:Organization
Organization Name:PIEDMONT PREFERRED WOMEN'S HEALTHCARE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDUL-MBACKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-956-1013
Mailing Address - Street 1:6890 GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-3555
Mailing Address - Country:US
Mailing Address - Phone:276-956-1013
Mailing Address - Fax:
Practice Address - Street 1:6890 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148-3555
Practice Address - Country:US
Practice Address - Phone:276-956-1013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241089207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty