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NPI Code Detail

MEDICARE: CENTRAL GEORGIA WOMEN'S HEALTH CENTER, LLC

MEDICARE: CENTRAL GEORGIA WOMEN'S HEALTH CENTER, 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
1207VG0400XGynecology Physician
2207VX0000XObstetrics Physician
3207V00000XObstetrics & Gynecology Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CJ6093OTHERGARAIL ROAD MEDICARE GROUP

General Provider Information

NPI Number : 1811922156
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL GEORGIA WOMEN'S HEALTH CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 4687
Second Line :
City : MACON
State : GA
Zip : 31208-4687
Country : US
Telephone Number : 478-746-1333
Fax Number : 478-738-8638
Provider Business Practice Location Address
First Line : 2410 INGLESIDE AVE
Second Line :
City : MACON
State : GA
Zip : 31204-2036
Country : US
Telephone Number : 478-746-1333
Fax Number : 478-738-8638
Authorized Official
Title or Position : OWNER
Name : DR. HENRY J DAVIS
Credential : M.D.
Telephone Number : 478-746-1333
Provider Enumeration Date : 07/12/2006
Last Update Date : 12/11/2007

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Directions to “CENTRAL GEORGIA WOMEN'S HEALTH CENTER, LLC ” Practice Location

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