Provider Demographics
NPI:1871615997
Name:GYNECOLOGY & WELLNESS CENTER, P.C.
Entity type:Organization
Organization Name:GYNECOLOGY & WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUNNELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-502-9888
Mailing Address - Street 1:2290 MOORES MILL ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830
Mailing Address - Country:US
Mailing Address - Phone:334-502-9888
Mailing Address - Fax:334-502-9190
Practice Address - Street 1:2290 MOORES MILL ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830
Practice Address - Country:US
Practice Address - Phone:334-502-9888
Practice Address - Fax:334-502-9190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20979261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51503912OtherBCBS OF AL
ALG64771Medicare UPIN
AL51503912OtherBCBS OF AL