Basic Information
| Provider Information | |||||||||
| NPI: | 1225253842 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS SPECIALTY CENTER OF NORTH GEORGIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 J L WHITE DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | JASPER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301434893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066923539 | ||||||||
| FaxNumber: | 7066929364 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 J L WHITE DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | JASPER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301434893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066923539 | ||||||||
| FaxNumber: | 7066929364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOLINARI | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7066923539 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VH0002X | 053200 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00221592G | 05 | GA | MEDICAID |