Provider Demographics
NPI:1548093677
Name:CARONETTE FIBROID AND PELVIC WELLNESS CENTER
Entity type:Organization
Organization Name:CARONETTE FIBROID AND PELVIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:STITT
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:706-662-3129
Mailing Address - Street 1:11886 HEALING WAY STE 520
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7917
Mailing Address - Country:US
Mailing Address - Phone:240-524-7272
Mailing Address - Fax:
Practice Address - Street 1:314 PHARR RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2486
Practice Address - Country:US
Practice Address - Phone:844-200-1715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty