Healthcare Provider Details

I. General information

NPI: 1740372598
Provider Name (Legal Business Name): ELBERTON WOMEN'S SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CHESTNUT ST THIRD FLOOR
ELBERTON GA
30635-1805
US

IV. Provider business mailing address

41 CHESTNUT ST THIRD FLOOR
ELBERTON GA
30635-1805
US

V. Phone/Fax

Practice location:
  • Phone: 706-213-1688
  • Fax: 706-213-1690
Mailing address:
  • Phone: 706-213-1688
  • Fax: 706-213-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number024820
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID MICHAEL HAGINS
Title or Position: OWNER
Credential: M.D.
Phone: 706-213-1688