Provider Demographics
NPI:1912969296
Name:EDGEWATER WOMEN'S HEALTH CENTRE
Entity Type:Organization
Organization Name:EDGEWATER WOMEN'S HEALTH CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-799-1012
Mailing Address - Street 1:PO BOX 3484
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3484
Mailing Address - Country:US
Mailing Address - Phone:704-799-1012
Mailing Address - Fax:704-799-1016
Practice Address - Street 1:548 WILLIAMSON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9111
Practice Address - Country:US
Practice Address - Phone:704-799-1012
Practice Address - Fax:704-799-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014GTOtherBC/BS NC