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General NPI Number Information
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NPI Number | 1811486905
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER OF WOMEN'S CHOICE
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 1874 PIEDMONT AVE NE STE 580E
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City | ATLANTA
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State | GA
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Zip | 30324-4975
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Country | US
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Telephone | 404-602-4495
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Fax | 404-607-1745
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Provider Business Mailing Address
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Address Line | 1874 PIEDMONT AVE NE STE 580E
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City | ATLANTA
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State | GA
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Zip | 30324-4975
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Country | US
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Telephone | 404-602-4495
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Fax | 404-607-1745
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Authorized Official
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Title or Position | CREDENTIALING CONSULTANT
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Name | FRAN BOLDEN
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Credential |
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Telephone | 256-325-0896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 51987
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License Number State | GA
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