Healthcare Provider Details

I. General information

NPI: 1598920423
Provider Name (Legal Business Name): FEMINA HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 S CHEROKEE LN BUILDING 1400
WOODSTOCK GA
30188-4461
US

IV. Provider business mailing address

3229 S CHEROKEE LN BUILDING 1400
WOODSTOCK GA
30188-4461
US

V. Phone/Fax

Practice location:
  • Phone: 678-445-8181
  • Fax: 678-445-8162
Mailing address:
  • Phone: 678-445-8181
  • Fax: 678-445-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number038678
License Number StateGA

VIII. Authorized Official

Name: MS. LORRI LACZYNSKI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 678-445-8181