Provider Demographics
NPI:1629374418
Name:ATLANTA WEST WOMEN'S CENTER
Entity type:Organization
Organization Name:ATLANTA WEST WOMEN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASWANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHADDHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-920-9745
Mailing Address - Street 1:4904 TIMBER RIDGE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1828
Mailing Address - Country:US
Mailing Address - Phone:770-920-9745
Mailing Address - Fax:770-920-9760
Practice Address - Street 1:4904 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1828
Practice Address - Country:US
Practice Address - Phone:770-920-9745
Practice Address - Fax:770-920-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA35023261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000478244BMedicaid
GA16BDCRVMedicare PIN
GA000478244BMedicaid