Healthcare Provider Details

I. General information

NPI: 1811527930
Provider Name (Legal Business Name): EXPRESS GYN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL RD NW STE 243
ATLANTA GA
30327-4100
US

IV. Provider business mailing address

307 SUMMER GARDEN DR
MARIETTA GA
30064-5044
US

V. Phone/Fax

Practice location:
  • Phone: 770-702-0101
  • Fax:
Mailing address:
  • Phone: 404-423-8132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LAVETTE WELCH
Title or Position: OWNER
Credential: MD
Phone: 404-423-8132