NPIMap

Organization Active NPI

Mountains Women'S Center LLC

  • Obstetrics & Gynecology Physician
  • Marietta, GA
National Provider Identifier
1053012260
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MOUNTAINS WOMEN'S CENTER LLC
Doing business as
Mountains Women's Center
Practice address
1611 Sands Place
Suite 100
Marietta, GA 30067
Phone
(678) 944-8042
Fax
(678) 293-7579
NPI assigned
Mar 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber Glenn, M.D.NPI 1275995029
Title
Owner, Physician
Phone
(678) 944-8042

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X

Addresses

Primary practice location

1611 Sands Place
Suite 100
Marietta, GA 30067

Mailing address

1611 Sands Place
Suite 100
Marietta, GA 30067
Phone (678) 944-8042

Other names 1

  • Mountains Women's Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230714000302 GA Part B Supplier - Clinic/Group Practice 0345600953 Receives reassigned benefits from 1 practitioner
Practice locations: Marietta, GA; Smyrna, GA

National Provider Directory

National Provider Directory

Locations

1611 Sands Pl SE
Ste 100
Marietta, GA 30067
Phone (678) 944-8042

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1053012260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 SANDS PLACE",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30067",
            "telephone_number": "678-944-8042",
            "fax_number": "678-293-7579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 SANDS PLACE",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30067",
            "telephone_number": "678-944-8042",
            "fax_number": "678-293-7579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINS WOMEN'S CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-14",
        "last_updated": "2024-10-29",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OWNER, PHYSICIAN",
        "authorized_official_telephone_number": "678-944-8042",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountains Women's Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.