MEDICARE: COMPREHENSIVE WOMEN'S HEALTHCARE ATLANTA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	033047	GA

General Provider Information

NPI Number	:	1235433103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE WOMEN'S HEALTHCARE ATLANTA, LLC

Provider Business Mailing Address
First Line	:	809 CLEVELAND AVE SW
Second Line	:	SUITE 101
City	:	ATLANTA
State	:	GA
Zip	:	30315-7108
Country	:	US
Telephone Number	:	404-767-2536
Fax Number	:

Provider Business Practice Location Address
First Line	:	809 CLEVELAND AVE SW
Second Line	:	SUITE 101
City	:	ATLANTA
State	:	GA
Zip	:	30315-7108
Country	:	US
Telephone Number	:	404-767-2536
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KIM CARROLL
Credential	:	MD
Telephone Number	:	404-767-2536

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	09/30/2011

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