MEDICARE: FEMINA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1235374331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEMINA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3229 S CHEROKEE LN BLDG 1400
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4461
Country	:	US
Telephone Number	:	678-445-8181
Fax Number	:	678-445-8162

Provider Business Practice Location Address
First Line	:	3229 S CHEROKEE LN BLDG 1400
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-4461
Country	:	US
Telephone Number	:	678-445-8181
Fax Number	:	678-445-8162

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	LORRI LACZYNSKI
Credential	:
Telephone Number	:	678-445-8181

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	01/06/2009

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Directions to “FEMINA HEALTHCARE LLC ” Practice Location

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