Provider Demographics
NPI:1306929104
Name:THE WOMEN'S WELLNESS CENTER
Entity type:Organization
Organization Name:THE WOMEN'S WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:SVENSSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-970-5073
Mailing Address - Street 1:1518 N MCKENZIE ST
Mailing Address - Street 2:SUITE 412
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2236
Mailing Address - Country:US
Mailing Address - Phone:251-970-5073
Mailing Address - Fax:251-970-1527
Practice Address - Street 1:1518 N MCKENZIE ST
Practice Address - Street 2:SUITE 412
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2236
Practice Address - Country:US
Practice Address - Phone:251-970-5073
Practice Address - Fax:251-970-1527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15478207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934279Medicaid
ALE90076Medicare UPIN
AL009934279Medicaid