Healthcare Provider Details

I. General information

NPI: 1811562408
Provider Name (Legal Business Name): WOMEN'S COMP HEALTHCARE CTR. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HAWTHORNE AVE STE M1000
ATHENS GA
30606-2168
US

IV. Provider business mailing address

1000 HAWTHORNE AVE STE M1000
ATHENS GA
30606-2168
US

V. Phone/Fax

Practice location:
  • Phone: 706-548-8010
  • Fax:
Mailing address:
  • Phone: 706-548-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KAUSHIK SHAH
Title or Position: OWNER
Credential: MD
Phone: 706-548-8010