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General NPI Number Information
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NPI Number | 1477698710
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Entity Type | Organization
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Legal Business Name | PREMIER WOMENS SPECIALIST LLC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 2675 N DECATUR RD STE 501
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City | DECATUR
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State | GA
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Zip | 30033-6134
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Country | US
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Telephone | 404-296-1424
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Fax | 404-501-7393
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Provider Business Mailing Address
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Address Line | 2675 N DECATUR RD STE 501
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City | DECATUR
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State | GA
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Zip | 30033-6134
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Country | US
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Telephone | 404-296-1424
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Fax | 404-501-7393
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KEVIN M DAUS
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Credential |
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Telephone | 404-296-1424
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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 | 26626
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12125
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License Number State | AL
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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 | 02839
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 028394
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License Number State | GA
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