Organization
WELLNESS FOR THE AGELESS WOMAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA BATES (PRACTICE ADMINISTRATOR)
(770) 333-9405
Entity
Organization
Contact information
Practice address
4168 LOCH HIGHLAND PKWY NE, ROSWELL, GA 30075-2026
(770) 333-9405
(770) 333-9406
Mailing address
PO BOX 670927, MARIETTA, GA 30066-0133
(770) 333-9405
(770) 333-9406
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
033212
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000434805I
—
GA
Enumeration date
07/29/2011
Last updated
07/29/2011
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