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PREMIER WOMENS OBGYN LLC NPI 1083819429


NPI Information

NPI: 1083819429
Provider Name: PREMIER WOMENS OBGYN, LLC
Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 11D2185143

Address:
237 UPPER RIVERDALE RD SW
RIVERDALE, GA
ZIP 30274
Phone: (770) 909-5003
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PREMIER WOMENS OBGYN, LLC is an obstetrics gynecology in Riverdale, GA. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. PREMIER WOMENS OBGYN, LLC NPI is 1083819429. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

237 UPPER RIVERDALE RD SW
RIVERDALE, GA
ZIP 30274-537
Phone: (770) 909-5003
Fax: (770) 909-5004

The provider's authorized official is Tracey Blander .
The authorized official title is Practice Management Consultant and has the following contact phone number (770) 716-6203.

The CLIA number assigned to this NPI record is 11D2185143 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/17/2007 and was last updated on 3/4/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology054127GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1547811054AMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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