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General NPI Number Information
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NPI Number | 1619157989
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Entity Type | Organization
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Legal Business Name | ATLANTA GWINNETT WOMEN'S SPECIALISTS
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 766 WALTHER RD SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8765
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Country | US
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Telephone | 770-963-2485
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Fax |
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Provider Business Mailing Address
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Address Line | 766 WALTHER RD SUITE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8765
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Country | US
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Telephone | 770-963-2485
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEMUEL G. VILLANUEVA
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Credential | MD
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Telephone | 770-963-2485
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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 | 047375
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License Number State | GA
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