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General NPI Number Information
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NPI Number | 1053012260
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Entity Type | Organization
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Legal Business Name | MOUNTAINS WOMEN'S CENTER LLC
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Dates
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Enumeration Date | 03/14/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1611 SANDS PLACE SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-944-8042
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Fax | 678-293-7579
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Provider Business Mailing Address
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Address Line | 1611 SANDS PLACE SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30067
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Country | US
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Telephone | 678-944-8042
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Fax | 678-293-7579
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | AMBER GLENN
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Credential | M.D.
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Telephone | 678-944-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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