Provider Demographics
NPI:1649460940
Name:PREMIER WOMEN'S HEALTHCARE LLC
Entity type:Organization
Organization Name:PREMIER WOMEN'S HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR/OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-418-6990
Mailing Address - Street 1:5900 HILLANDALE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3892
Mailing Address - Country:US
Mailing Address - Phone:678-418-6990
Mailing Address - Fax:678-418-6986
Practice Address - Street 1:5900 HILLANDALE DR STE 325
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3892
Practice Address - Country:US
Practice Address - Phone:678-418-6990
Practice Address - Fax:678-418-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000740737IMedicaid
GAG46213 GAMedicare UPIN