Healthcare Provider Details

I. General information

NPI: 1770697104
Provider Name (Legal Business Name): FEMINIST WOMEN'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 CLIFF VALLEY WAY NE
ATLANTA GA
30329-2421
US

IV. Provider business mailing address

1924 CLIFF VALLEY WAY NE
ATLANTA GA
30329-2421
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-7900
  • Fax: 404-728-7907
Mailing address:
  • Phone: 404-728-7900
  • Fax: 404-728-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KWAJELYN JACKSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 404-248-5452