Healthcare Provider Details

I. General information

NPI: 1073014163
Provider Name (Legal Business Name): WOMENS HEALTH INSTITUTE OF STOCKBRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ARKWRIGHT LNDG
MACON GA
31210-1364
US

IV. Provider business mailing address

112 ARKWRIGHT LNDG
MACON GA
31210-1364
US

V. Phone/Fax

Practice location:
  • Phone: 478-746-2888
  • Fax: 478-746-2889
Mailing address:
  • Phone: 478-746-2888
  • Fax: 478-746-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NNAEMEKA MADUKA UMERAH
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 478-746-2888