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General NPI Number Information
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NPI Number | 1619000312
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Entity Type | Organization
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Legal Business Name | WOMENS HEALTHCARE AND AESTHETICS
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5910 HILLANDALE DR STE 201
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City | LITHONIA
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State | GA
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Zip | 30058-1878
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Country | US
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Telephone | 770-760-8484
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Fax | 770-760-7664
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Provider Business Mailing Address
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Address Line | 1403 MANCHESTER DR NE
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City | CONYERS
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State | GA
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Zip | 30012-3879
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Country | US
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Telephone | 770-760-8484
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Fax | 770-760-7664
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MELANIE MCMULLEN
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Credential |
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Telephone | 770-760-8484
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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 | 035507
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License Number State | GA
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