Basic Information
| Provider Information | |||||||||
| NPI: | 1245298017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREFERRED WOMEN'S HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300458708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625100 | ||||||||
| FaxNumber: | 7709622400 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300458708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709625100 | ||||||||
| FaxNumber: | 7709622400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 02/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | DICKERSON | ||||||||
| AuthorizedOfficialFirstName: | BYRON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7709625100 | ||||||||
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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 | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.