Provider Demographics
NPI:1669572541
Name:THE WOMAN'S CARE CENTER
Entity type:Organization
Organization Name:THE WOMAN'S CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN INOCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-453-8100
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31059-0669
Mailing Address - Country:US
Mailing Address - Phone:478-453-8100
Mailing Address - Fax:478-453-8186
Practice Address - Street 1:1001 FERNWOOD DR
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-5416
Practice Address - Country:US
Practice Address - Phone:478-453-8100
Practice Address - Fax:478-453-8186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000833566DMedicaid
GAGRP7670Medicare ID - Type Unspecified
GA000833566DMedicaid