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General NPI Number Information
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NPI Number | 1356387716
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Entity Type | Organization
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Legal Business Name | IMMANUEL WOMEN'S CENTER, L.L.C
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 106 HOSPITAL DR SUITE 6
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City | CHATSWORTH
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State | GA
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Zip | 30705-2070
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Country | US
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Telephone | 706-517-4444
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Fax | 706-517-4455
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Provider Business Mailing Address
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Address Line | PO BOX 1868
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City | DALTON
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State | GA
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Zip | 30722-1868
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Country | US
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Telephone | 706-517-4444
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Fax | 706-517-4455
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. BENJAMIN NWADIKE
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Credential |
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Telephone | 404-759-7318
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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 | 56863
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License Number State | GA
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