MEDICARE: DUNWOODY WOMEN'S MEDICAL GROUP, L.L.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	0013298	GA

General Provider Information

NPI Number	:	1902042245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNWOODY WOMEN'S MEDICAL GROUP, L.L.C.

Provider Business Mailing Address
First Line	:	3114 MERCER UNIVERSITY DR
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30341-4144
Country	:	US
Telephone Number	:	404-454-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 MERCER UNIVERSITY DR
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30341-4144
Country	:	US
Telephone Number	:	404-454-8080
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER BEATO
Credential	:
Telephone Number	:	404-454-8080

Provider Enumeration Date	:	12/16/2008
Last Update Date	:	12/16/2008

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