Provider Demographics
NPI:1154434660
Name:DECATUR PHYSICIANS FOR WOMEN, P.C.
Entity type:Organization
Organization Name:DECATUR PHYSICIANS FOR WOMEN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-350-9700
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-0548
Mailing Address - Country:US
Mailing Address - Phone:256-350-9700
Mailing Address - Fax:256-350-9797
Practice Address - Street 1:1874 BELTLINE RD SW
Practice Address - Street 2:SUITE 300
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-5514
Practice Address - Country:US
Practice Address - Phone:256-350-9700
Practice Address - Fax:256-350-9797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529921630Medicaid
ALK234OtherMEDICARE PTAN
AL529921630Medicaid
ALK234Medicare PIN