Basic Information
| Provider Information | |||||||||
| NPI: | 1225366214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPASSIONATE CARE FOR WOMEN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60879 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314200879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9129202995 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5354 REYNOLDS ST STE 420 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123556990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 09/11/2011 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | NKENGE | ||||||||
| AuthorizedOfficialMiddleName: | AYEOLA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9129202995 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 058969 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.