Healthcare Provider Details

I. General information

NPI: 1912969296
Provider Name (Legal Business Name): EDGEWATER WOMEN'S HEALTH CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 WILLIAMSON RD SUITE 2
MOORESVILLE NC
28117-9111
US

IV. Provider business mailing address

PO BOX 3484
MOORESVILLE NC
28117-3484
US

V. Phone/Fax

Practice location:
  • Phone: 704-799-1012
  • Fax: 704-799-1016
Mailing address:
  • Phone: 704-799-1012
  • Fax: 704-799-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GRETA YVONNE WATTS
Title or Position: OWNER
Credential: MD
Phone: 704-799-1012