Provider Demographics
NPI:1588868798
Name:JUST FOR WOMEN
Entity type:Organization
Organization Name:JUST FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-994-8827
Mailing Address - Street 1:823 HIGHWAY 138 SW
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3362
Mailing Address - Country:US
Mailing Address - Phone:770-994-8827
Mailing Address - Fax:770-994-8610
Practice Address - Street 1:823 HIGHWAY 138 SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3362
Practice Address - Country:US
Practice Address - Phone:770-994-8827
Practice Address - Fax:770-994-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE90164Medicare UPIN
GA16BDFVDMedicare ID - Type UnspecifiedMEDICARE