Healthcare Provider Details

I. General information

NPI: 1700652575
Provider Name (Legal Business Name): CLINICA MATERNAL DE LA MUJER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 HOLCOMB BRIDGE RD STE 200
ROSWELL GA
30076-1900
US

IV. Provider business mailing address

861 HOLCOMB BRIDGE RD STE 200
ROSWELL GA
30076-1900
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-9276
  • Fax: 770-910-9278
Mailing address:
  • Phone: 770-910-9276
  • Fax: 770-910-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARTHA GOMEZ
Title or Position: CEO
Credential:
Phone: 864-617-9410