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General NPI Number Information
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NPI Number | 1316193667
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Entity Type | Organization
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Legal Business Name | GENESIS WOMEN'S CARE LLC
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 190 CURTIS PKWY NE SUITE B
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City | CALHOUN
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State | GA
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Zip | 30701-2057
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Country | US
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Telephone | 706-629-7380
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Fax | 706-629-5406
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Provider Business Mailing Address
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Address Line | PO BOX 2105
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City | CALHOUN
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State | GA
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Zip | 30703-2105
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Country | US
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Telephone | 706-629-7380
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Fax | 706-629-5406
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHANIE J BROGDEN
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Credential | M.D.
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Telephone | 706-629-7380
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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 | 051437
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License Number State | GA
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