Provider Demographics
NPI:1871346676
Name:GENESIS WOMEN'S HEALTH & MIDWIFERY CENTER LLC
Entity type:Organization
Organization Name:GENESIS WOMEN'S HEALTH & MIDWIFERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN-PYE
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, MA-HSC, MACE
Authorized Official - Phone:404-218-9496
Mailing Address - Street 1:2788 BAYARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3440
Mailing Address - Country:US
Mailing Address - Phone:404-291-8028
Mailing Address - Fax:
Practice Address - Street 1:2788 BAYARD ST STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-3440
Practice Address - Country:US
Practice Address - Phone:404-218-9496
Practice Address - Fax:404-748-4942
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS BIRTH CONCEPTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-10
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1760585111Medicaid