Provider Demographics
NPI:1295514214
Name:WOMEN'S CENTER FOR ADVANCED SURGERY OF COVINGTON, LLC
Entity type:Organization
Organization Name:WOMEN'S CENTER FOR ADVANCED SURGERY OF COVINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-391-3500
Mailing Address - Street 1:1948 OLD OCILLA RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1644
Mailing Address - Country:US
Mailing Address - Phone:229-391-3500
Mailing Address - Fax:
Practice Address - Street 1:10600 LOCHRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-4411
Practice Address - Country:US
Practice Address - Phone:229-391-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical