MEDICARE: SOUTHERN WOMEN'S HEALTH, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922184274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN WOMEN'S HEALTH, PLLC

Provider Business Mailing Address
First Line	:	6524 U S HIGHWAY 98
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-8569
Country	:	US
Telephone Number	:	601-268-9393
Fax Number	:	601-268-9559

Provider Business Practice Location Address
First Line	:	5003 HARDY ST STE 300
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-1331
Country	:	US
Telephone Number	:	601-261-5835
Fax Number	:	601-261-5739

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HOLLEY JOHNSON
Credential	:
Telephone Number	:	601-450-9425

Provider Enumeration Date	:	10/30/2006
Last Update Date	:	12/27/2023

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