Healthcare Provider Details

I. General information

NPI: 1053936765
Provider Name (Legal Business Name): EVERY WOMAN'S OB-GYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N PARK TRL
STOCKBRIDGE GA
30281-7373
US

IV. Provider business mailing address

100 MISSING LAKE DR
ELLENWOOD GA
30294-3191
US

V. Phone/Fax

Practice location:
  • Phone: 678-881-0020
  • Fax: 706-641-0277
Mailing address:
  • Phone: 706-495-8750
  • Fax:

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: TEMITOPE FAPOHUNDA
Title or Position: OWNER
Credential: MD
Phone: 706-495-8750