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General NPI Number Information
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NPI Number | 1285844498
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Entity Type | Organization
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Legal Business Name | SOUTHERN CENTER FOR WOMENS HEALTH PC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 310 S LEWIS ST
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City | LAGRANGE
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State | GA
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Zip | 30240-3144
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Country | US
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Telephone | 706-845-0500
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Fax | 706-812-9315
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Provider Business Mailing Address
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Address Line | 310 S LEWIS ST
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City | LAGRANGE
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State | GA
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Zip | 30240-3144
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Country | US
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Telephone | 706-845-0500
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Fax | 706-812-9315
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. JAMES J BENDELL
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Credential | MD
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Telephone | 706-845-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 043546
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State |
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