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General NPI Number Information
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NPI Number | 1417079682
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Entity Type | Organization
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Legal Business Name | THE BREAST HEALTH CLINIC, PC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 325 NORTH JEFF DAVIS DRIVE
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-461-1337
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Fax | 770-461-0922
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Provider Business Mailing Address
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Address Line | 325 NORTH JEFF DAVIS DRIVE
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-461-1337
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Fax | 770-461-0922
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN PETER AUDA
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Credential | M.D.
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Telephone | 770-461-1337
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 020653
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License Number State | GA
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