MEDICARE: PHOENIX WOMEN'S CENTER, P.C.

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	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1487693875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX WOMEN'S CENTER, P.C.

Provider Business Mailing Address
First Line	:	1720 PHOENIX BLVD
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5594
Country	:	US
Telephone Number	:	404-446-4792
Fax Number	:	404-446-4793

Provider Business Practice Location Address
First Line	:	1720 PHOENIX BLVD
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-5594
Country	:	US
Telephone Number	:	404-446-4792
Fax Number	:	404-446-4793

Authorized Official
Title or Position	:	MANAGER
Name	:	LESA CREWS
Credential	:
Telephone Number	:	404-446-4792

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	11/11/2008

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Directions to “PHOENIX WOMEN'S CENTER, P.C. ” Practice Location

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