Basic Information
| Provider Information | |||||||||
| NPI: | 1245652726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE KANE CLINIC'S | ||||||||
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| OtherOrganizationName: | INTERNATIONAL WOMEN'S HEALTH SERVICES-CIMA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 CLEARVIEW AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | DORAVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303402100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 CLEARVIEW AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | DORAVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303402100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2014 | ||||||||
| LastUpdateDate: | 01/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | QUINTERO | ||||||||
| AuthorizedOfficialFirstName: | MARCELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4042504447 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.