Provider Demographics
NPI:1295906709
Name:SIGNATURE WOMEN'S HEALTHCARE
Entity type:Organization
Organization Name:SIGNATURE WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MCKAY
Authorized Official - Last Name:MERRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-380-1200
Mailing Address - Street 1:2775 CRUSE RD
Mailing Address - Street 2:STE 2101
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7140
Mailing Address - Country:US
Mailing Address - Phone:404-380-1200
Mailing Address - Fax:404-380-7494
Practice Address - Street 1:2775 CRUSE RD
Practice Address - Street 2:STE 2101
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7140
Practice Address - Country:US
Practice Address - Phone:404-380-1200
Practice Address - Fax:404-380-7494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000867578CMedicaid
GAGRP6034Medicare PIN