Provider Demographics
NPI:1861729626
Name:TOTAL WOMEN'S CARE OB-GYN, PA
Entity type:Organization
Organization Name:TOTAL WOMEN'S CARE OB-GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-565-3925
Mailing Address - Street 1:375 TEAL DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2527
Mailing Address - Country:US
Mailing Address - Phone:910-565-3925
Mailing Address - Fax:910-565-3922
Practice Address - Street 1:375 TEAL DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-2527
Practice Address - Country:US
Practice Address - Phone:910-565-3925
Practice Address - Fax:910-565-3922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC189136XMMedicaid
NC189136XMMedicaid