Healthcare Provider Details

I. General information

NPI: 1831241660
Provider Name (Legal Business Name): SUMMERVILLE WOMEN'S MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WRIGHTSBORO RD
AUGUSTA GA
30904-6220
US

IV. Provider business mailing address

2300 WRIGHTSBORO RD
AUGUSTA GA
30904-6220
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-3948
  • Fax: 706-737-4035
Mailing address:
  • Phone: 706-737-3948
  • Fax: 706-737-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CECELIA T FLANDERS
Title or Position: INSURANCE ADMIN
Credential: CMC
Phone: 706-737-3948