Healthcare Provider Details

I. General information

NPI: 1821359258
Provider Name (Legal Business Name): WOMEN'S SPECIALIST OF NORTH GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 LAWRENCEVILLE HWY
LAWRENCEVILLE GA
30044-7710
US

IV. Provider business mailing address

2169 LAWRENCEVILLE HWY
LAWRENCEVILLE GA
30044-7710
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-5878
  • Fax: 770-202-7101
Mailing address:
  • Phone: 770-676-5878
  • Fax: 770-202-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number061881
License Number StateGA

VIII. Authorized Official

Name: DANIEL ESTEVES
Title or Position: MD
Credential:
Phone: 770-676-5878