Basic Information
| Provider Information | |||||||||
| NPI: | 1306984927 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLETE WOMENS HEALTHCARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10710 MEDLOCK BRIDGE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706229810 | ||||||||
| FaxNumber: | 7706229811 | ||||||||
| Practice Location | |||||||||
| Address1: | 10710 MEDLOCK BRIDGE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706229810 | ||||||||
| FaxNumber: | 7706229811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2007 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | KASPAREK | ||||||||
| AuthorizedOfficialFirstName: | DORIGEN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7706229810 | ||||||||
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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 | 174400000X | GA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 207V00000X | 054445 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.