MEDICARE: ACADEMY OF WOMEN'S AND CHILDREN'S HEALTH, 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

General Provider Information

NPI Number	:	1760641278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY OF WOMEN'S AND CHILDREN'S HEALTH, LLC

Provider Business Mailing Address
First Line	:	2803 WRIGHTSBORO RD
Second Line	:	SUITE 45
City	:	AUGUSTA
State	:	GA
Zip	:	30909-3913
Country	:	US
Telephone Number	:	706-736-2737
Fax Number	:	706-364-5808

Provider Business Practice Location Address
First Line	:	2803 WRIGHTSBORO RD
Second Line	:	SUITE 45
City	:	AUGUSTA
State	:	GA
Zip	:	30909-3913
Country	:	US
Telephone Number	:	706-736-2737
Fax Number	:	706-364-5808

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK BOWLING
Credential	:
Telephone Number	:	706-650-1332

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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