Healthcare Provider Details

I. General information

NPI: 1386988301
Provider Name (Legal Business Name): INNOVATIVE WOMEN'S HEALTHCARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 S COBB DR SE #105
SMYRNA GA
30080-8504
US

IV. Provider business mailing address

3200 HIGHLANDS PKWY SE STE 420
SMYRNA GA
30082-5192
US

V. Phone/Fax

Practice location:
  • Phone: 678-424-1123
  • Fax:
Mailing address:
  • Phone: 678-424-1123
  • Fax: 678-424-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MELINDA MILLER-THRASHER
Title or Position: OWNER
Credential: MD
Phone: 678-424-1126