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General NPI Number Information
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NPI Number | 1265725261
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Entity Type | Organization
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Legal Business Name | WOMENS LINK SPECIALTY OBSTETRICAL REFERRAL CLINIC PLLC
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Dates
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Enumeration Date | 05/24/2011
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 3901 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75075-7738
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Country | US
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Telephone | 972-519-1212
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Fax | 972-519-1248
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Provider Business Mailing Address
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Address Line | PO BOX 741669
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City | ATLANTA
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State | GA
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Zip | 30374-1669
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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 | PARTNER
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Name | JACK GRAHAM
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Credential | MD
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Telephone | 972-519-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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