MEDICARE: PREMIER WOMENS SPECIALIST 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	26626	KY
2	207V00000X	Obstetrics & Gynecology Physician	12125	AL
3	207V00000X	Obstetrics & Gynecology Physician	02839	GA
4	207V00000X	Obstetrics & Gynecology Physician	028394	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00345500	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477698710	OTHER		NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	118352	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1477698710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER WOMENS SPECIALIST LLC

Provider Business Mailing Address
First Line	:	2675 N DECATUR RD STE 501
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6134
Country	:	US
Telephone Number	:	404-296-1424
Fax Number	:	404-501-7393

Provider Business Practice Location Address
First Line	:	2675 N DECATUR RD STE 501
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6134
Country	:	US
Telephone Number	:	404-296-1424
Fax Number	:	404-501-7393

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	KEVIN M DAUS
Credential	:
Telephone Number	:	404-296-1424

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/23/2023

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Directions to “PREMIER WOMENS SPECIALIST LLC ” Practice Location

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