MEDICARE: DOUGLAS WOMENS CENTER PC

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	207V00000X	GA

General Provider Information

NPI Number	:	1407840069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS WOMENS CENTER PC

Provider Business Mailing Address
First Line	:	880 CRESTMARK DR
Second Line	:	SUITE 200
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2646
Country	:	US
Telephone Number	:	770-941-8662
Fax Number	:	770-739-6006

Provider Business Practice Location Address
First Line	:	880 CRESTMARK DR
Second Line	:	SUITE 200
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-2646
Country	:	US
Telephone Number	:	770-941-8662
Fax Number	:	770-739-6006

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LISA ORTENZI
Credential	:	MD
Telephone Number	:	770-941-8662

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	11/22/2010

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Directions to “DOUGLAS WOMENS CENTER PC ” Practice Location

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