1649434952 NPI number — NORTH METRO WOMENS'S HEALTHCARE P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649434952 NPI number — NORTH METRO WOMENS'S HEALTHCARE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH METRO WOMENS'S HEALTHCARE P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649434952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601A PROFESSIONAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30045-3004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-338-8331
Provider Business Mailing Address Fax Number:
770-338-9499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601A PROFESSIONAL DR
Provider Second Line Business Practice Location Address:
SUITE 290
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30045-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-338-8331
Provider Business Practice Location Address Fax Number:
770-338-9499
Provider Enumeration Date:
07/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ODURO
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
770-310-2343

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  52215 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 621555898A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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