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General NPI Number Information
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NPI Number | 1164663175
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Entity Type | Organization
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Legal Business Name | THE WOMENS CENTER OF CENTRAL GEORGIA
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 427 POPLAR ST
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City | MACON
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State | GA
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Zip | 31201-3335
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Country | US
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Telephone | 478-742-8466
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26040
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City | MACON
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State | GA
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Zip | 31221-6040
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | INS COORD
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Name | TONYA SUTTON
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Credential |
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Telephone | 478-475-1299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 045037
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License Number State | GA
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