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General NPI Number Information
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NPI Number | 1669572541
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Entity Type | Organization
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Legal Business Name | THE WOMAN'S CARE CENTER
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 1001 FERNWOOD DR
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-5416
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Country | US
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Telephone | 478-453-8100
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Fax | 478-453-8186
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | MILLEDGEVILLE
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State | GA
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Zip | 31059-0669
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Country | US
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Telephone | 478-453-8100
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Fax | 478-453-8186
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Authorized Official
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Title or Position | OWNER
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Name | MARISOL SAN INOCENCIO
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Credential | MD
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Telephone | 478-453-8100
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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 | 47654
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License Number State | GA
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