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General NPI Number Information
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NPI Number | 1720245624
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Entity Type | Organization
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Legal Business Name | GENESIS WOMEN'S CENTER PC
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 10/10/2016
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Provider Practice Location Address
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Address Line | 160 CURTIS PKWY NE
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City | CALHOUN
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State | GA
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Zip | 30701-2062
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Country | US
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Telephone | 706-629-7380
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Fax | 706-629-6789
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Provider Business Mailing Address
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Address Line | 106 CURTIS PARKWAY NE
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City | CALHOUN
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State | GA
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Zip | 30701
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Country | US
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Telephone | 706-629-7380
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Fax | 706-629-6789
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEPHANIE J BROGDEN
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Credential | MD
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Telephone | 706-629-7380
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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 | 051437
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License Number State | GA
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