Provider Demographics
NPI:1306984927
Name:COMPLETE WOMENS HEALTHCARE LLC
Entity type:Organization
Organization Name:COMPLETE WOMENS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIGEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KASPAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-622-9810
Mailing Address - Street 1:10710 MEDLOCK BRIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-622-9810
Mailing Address - Fax:770-622-9811
Practice Address - Street 1:10710 MEDLOCK BRIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-622-9810
Practice Address - Fax:770-622-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
GA054445207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46363Medicare UPIN