Provider Demographics
NPI:1356387716
Name:IMMANUEL WOMEN'S CENTER, L.L.C
Entity type:Organization
Organization Name:IMMANUEL WOMEN'S CENTER, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NWADIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-759-7318
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-1868
Mailing Address - Country:US
Mailing Address - Phone:706-517-4444
Mailing Address - Fax:706-517-4455
Practice Address - Street 1:106 HOSPITAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2070
Practice Address - Country:US
Practice Address - Phone:706-517-4444
Practice Address - Fax:706-517-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty