Healthcare Provider Details

I. General information

NPI: 1225253842
Provider Name (Legal Business Name): WOMENS SPECIALTY CENTER OF NORTH GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 J L WHITE DR SUITE 120
JASPER GA
30143-4893
US

IV. Provider business mailing address

220 J L WHITE DR SUITE 120
JASPER GA
30143-4893
US

V. Phone/Fax

Practice location:
  • Phone: 706-692-3539
  • Fax: 706-692-9364
Mailing address:
  • Phone: 706-692-3539
  • Fax: 706-692-9364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number053200
License Number StateGA

VIII. Authorized Official

Name: VINCENT G MOLINARI
Title or Position: OWNER
Credential: M.D.
Phone: 706-692-3539