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NPI Code Detail

MEDICARE: GARDEN GYNECOLOGY & WELLNESS GROUP LLC

MEDICARE: GARDEN GYNECOLOGY & WELLNESS GROUP 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
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1578416095
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARDEN GYNECOLOGY & WELLNESS GROUP LLC
Provider Business Mailing Address
First Line : 4300 PACES FERRY RD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5714
Country : US
Telephone Number : 470-750-7573
Fax Number : 470-752-6722
Provider Business Practice Location Address
First Line : 4300 PACES FERRY RD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5714
Country : US
Telephone Number : 470-750-7573
Fax Number : 470-750-6722
Authorized Official
Title or Position : OWNER
Name : KEISA ANDERSON
Credential : MD
Telephone Number : 678-799-6565
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “GARDEN GYNECOLOGY & WELLNESS GROUP LLC ” Practice Location

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