Healthcare Provider Details

I. General information

NPI: 1649981846
Provider Name (Legal Business Name): UROGYNECOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 STONE CREEK BLVD STE 200
FLOWOOD MS
39232-8210
US

IV. Provider business mailing address

778 LIBERTY RD
FLOWOOD MS
39232-9300
US

V. Phone/Fax

Practice location:
  • Phone: 769-243-6141
  • Fax: 601-510-1665
Mailing address:
  • Phone: 769-243-6141
  • Fax: 601-510-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN BATEN
Title or Position: OWNER
Credential: MD
Phone: 769-208-4437