=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780999425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALABAMA WOMEN'S WELLNESS CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2010
-----------------------------------------------------
Last Update Date | 08/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2125 EXECUTIVE PARK DR
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-6041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-356-2910
-----------------------------------------------------
Fax | 334-209-0094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 GUINEVERE CT
-----------------------------------------------------
City | OPELIKA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36801-2549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-356-2910
-----------------------------------------------------
Fax | 334-209-0094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. YASHICA ROBINSON WHITE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-356-2910
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 27133
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------