Healthcare Provider Details

I. General information

NPI: 1750112926
Provider Name (Legal Business Name): MAA WOMENS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 PEACHTREE PKWY STE 121
CUMMING GA
30041-9792
US

IV. Provider business mailing address

566 PEACHTREE PKWY STE 121
CUMMING GA
30041-9792
US

V. Phone/Fax

Practice location:
  • Phone: 470-866-3200
  • Fax: 470-866-3270
Mailing address:
  • Phone: 470-866-3200
  • Fax: 470-866-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PADMAVATHI V PAGADALA
Title or Position: OWNER
Credential: MD
Phone: 470-866-3200