Provider Demographics
NPI:1962413559
Name:CONCERNED CARE FOR WOMEN
Entity type:Organization
Organization Name:CONCERNED CARE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-474-6887
Mailing Address - Street 1:540 CHARTER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4892
Mailing Address - Country:US
Mailing Address - Phone:478-474-6887
Mailing Address - Fax:478-471-5292
Practice Address - Street 1:540 CHARTER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4892
Practice Address - Country:US
Practice Address - Phone:478-474-6887
Practice Address - Fax:478-471-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030516207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty