Healthcare Provider Details

I. General information

NPI: 1417167446
Provider Name (Legal Business Name): WOMEN'S COMMUNITY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

IV. Provider business mailing address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-2200
  • Fax: 770-991-1341
Mailing address:
  • Phone: 770-991-2200
  • Fax: 770-991-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ELIZABETH W KILLEBREW
Title or Position: PRESIDENT
Credential: MD
Phone: 770-991-2200