MEDICARE: ATLANTA WOMEN'S MEDICAL CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A2124	OTHER	GA	KAISER PERMANENTE
2	52261456001	OTHER	GA	BC/BS

General Provider Information

NPI Number	:	1427003599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA WOMEN'S MEDICAL CENTER

Provider Business Mailing Address
First Line	:	601 CHAPEL AVE E
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-1454
Country	:	US
Telephone Number	:	856-356-4025
Fax Number	:	856-356-4038

Provider Business Practice Location Address
First Line	:	235 W WIEUCA RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-3321
Country	:	US
Telephone Number	:	404-257-0057
Fax Number	:	404-257-1245

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	ANNE GRIFFIN
Credential	:
Telephone Number	:	856-356-4025

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	05/13/2014

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