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General NPI Number Information
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NPI Number | 1700652575
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Entity Type | Organization
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Legal Business Name | CLINICA MATERNAL DE LA MUJER
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 861 HOLCOMB BRIDGE RD STE 200
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City | ROSWELL
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State | GA
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Zip | 30076-1900
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Country | US
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Telephone | 770-910-9276
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Fax | 770-910-9278
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Provider Business Mailing Address
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Address Line | 861 HOLCOMB BRIDGE RD STE 200
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City | ROSWELL
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State | GA
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Zip | 30076-1900
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Country | US
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Telephone | 770-910-9276
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Fax | 770-910-9278
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Authorized Official
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Title or Position | CEO
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Name | MARTHA GOMEZ
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Credential |
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Telephone | 864-617-9410
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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 |
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License Number State |
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