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General NPI Number Information
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NPI Number | 1437554847
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Entity Type | Organization
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Legal Business Name | SOUTHERN CRESCENT WOMEN'S HEALTH SPECIALISTS
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 10/28/2014
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Provider Practice Location Address
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Address Line | 115 EAGLE SPRIGN DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 770-474-0064
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Fax | 770-474-2998
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Provider Business Mailing Address
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Address Line | 115 EAGLE SPRING DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6486
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Country | US
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Telephone | 770-474-0064
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Fax | 770-474-2998
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | LYNN STAPLETON
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Credential |
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Telephone | 770-474-0064
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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 | 67788
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License Number State | GA
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