Provider Demographics
NPI:1700652575
Name:CLINICA MATERNAL DE LA MUJER
Entity Type:Organization
Organization Name:CLINICA MATERNAL DE LA MUJER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-617-9410
Mailing Address - Street 1:861 HOLCOMB BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1900
Mailing Address - Country:US
Mailing Address - Phone:770-910-9276
Mailing Address - Fax:770-910-9278
Practice Address - Street 1:861 HOLCOMB BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1900
Practice Address - Country:US
Practice Address - Phone:770-910-9276
Practice Address - Fax:770-910-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty