Basic Information
| Provider Information | |||||||||
| NPI: | 1407089816 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERIDIAN WOMEN'S HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1829 INDEPENDENCE SQ | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303385153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705519616 | ||||||||
| FaxNumber: | 7703963647 | ||||||||
| Practice Location | |||||||||
| Address1: | 7823 KIVERTON PL | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303505889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705519616 | ||||||||
| FaxNumber: | 7703963647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2009 | ||||||||
| LastUpdateDate: | 09/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | NAOMI | ||||||||
| AuthorizedOfficialMiddleName: | RUTH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTITIONER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7705519616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 041823 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000935217C | 05 | GA | MEDICAID |