Healthcare Provider Details

I. General information

NPI: 1598708224
Provider Name (Legal Business Name): WOMENS HEALTH OF BLAIRSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 WEAVER RD SUITE A
BLAIRSVILLE GA
30512-3136
US

IV. Provider business mailing address

PO BOX 1145
BLAIRSVILLE GA
30514-1145
US

V. Phone/Fax

Practice location:
  • Phone: 706-745-9220
  • Fax:
Mailing address:
  • Phone: 706-745-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number45765
License Number StateGA

VIII. Authorized Official

Name: KEVINS S DAVIS
Title or Position: OWNER
Credential: MD
Phone: 706-745-9220