Healthcare Provider Details

I. General information

NPI: 1720782089
Provider Name (Legal Business Name): WOMENINCHARG3 GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/22/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 SATELLITE BLVD APT 311
DULUTH GA
30096-5081
US

IV. Provider business mailing address

4155 SATELLITE BLVD APT 311
DULUTH GA
30096-5081
US

V. Phone/Fax

Practice location:
  • Phone: 800-890-3571
  • Fax: 800-890-3571
Mailing address:
  • Phone: 800-890-3571
  • Fax: 800-890-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: SATOA RAYMOND
Title or Position: MEDICAL RECORDS SPECIALIST
Credential:
Phone: 678-907-2029