Provider Demographics
NPI:1831418227
Name:WOMEN'S HEALTHCARE SPECIALIST OF ATHENS LLC
Entity type:Organization
Organization Name:WOMEN'S HEALTHCARE SPECIALIST OF ATHENS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-369-1200
Mailing Address - Street 1:965 HAWTHORNE AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2139
Mailing Address - Country:US
Mailing Address - Phone:706-369-1200
Mailing Address - Fax:706-369-0540
Practice Address - Street 1:965 HAWTHORNE AVE
Practice Address - Street 2:SUITE 100A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2139
Practice Address - Country:US
Practice Address - Phone:706-369-1200
Practice Address - Fax:706-369-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty