Provider Demographics
NPI:1386075869
Name:CENTRAL GEORGIA WOMEN HEALTH CARE
Entity type:Organization
Organization Name:CENTRAL GEORGIA WOMEN HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:478-333-3591
Mailing Address - Street 1:225 SMITHVILLE CHURCH RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9092
Mailing Address - Country:US
Mailing Address - Phone:478-333-3591
Mailing Address - Fax:478-333-6857
Practice Address - Street 1:225 SMITHVILLE CHURCH RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-9092
Practice Address - Country:US
Practice Address - Phone:478-333-3591
Practice Address - Fax:478-333-6857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051574207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000967887BMedicaid
GA16BBCHJMedicare UPIN