Basic Information
| Provider Information | |||||||||
| NPI: | 1780739813 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERNATIONAL WOMENS HEALTH SERVICES PC | ||||||||
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| OtherOrganizationName: | CIMA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE # D | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
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| Practice Location | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE # D | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 06/21/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DOTT | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4042504447 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | GA | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Midwife | 363LX0001X | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 300036100A | 05 | GA | MEDICAID | 300036100D | 05 | GA | MEDICAID |