1912146556 NPI number — JUST FOR YOU WOMEN'S HEALTHCARE, INC

Table of content: (NPI 1912146556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912146556 NPI number — JUST FOR YOU WOMEN'S HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUST FOR YOU WOMEN'S HEALTHCARE, INC
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:
1912146556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 263
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCUST GROVE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30248-0263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-429-8146
Provider Business Mailing Address Fax Number:
678-429-8146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3334 HIGHWAY 155
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
LOCUST GROVE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30248-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-429-8146
Provider Business Practice Location Address Fax Number:
770-288-8642
Provider Enumeration Date:
02/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
LORIE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-429-8146

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  62054 , 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: 653434213B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com