Provider Demographics
NPI:1053416966
Name:WOMEN'S HEALTH ASSOCIATES OF WALTON, PC
Entity type:Organization
Organization Name:WOMEN'S HEALTH ASSOCIATES OF WALTON, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-267-8368
Mailing Address - Street 1:513 GREAT OAKS DR STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8211
Mailing Address - Country:US
Mailing Address - Phone:770-267-8368
Mailing Address - Fax:770-207-0640
Practice Address - Street 1:513 GREAT OAKS DR STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8211
Practice Address - Country:US
Practice Address - Phone:770-267-8368
Practice Address - Fax:770-207-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033967173000000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000542286BMedicaid
GA52431027OtherBC/BS
GA16BDDFCMedicare ID - Type Unspecified
GAF63961Medicare UPIN