Healthcare Provider Details

I. General information

NPI: 1396795571
Provider Name (Legal Business Name): SOUTHERN WOMEN'S HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6524 U S HIGHWAY 98
HATTIESBURG MS
39402-8569
US

IV. Provider business mailing address

6524 U S HIGHWAY 98
HATTIESBURG MS
39402-8569
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-9393
  • Fax: 601-268-9559
Mailing address:
  • Phone: 601-268-9393
  • Fax: 601-268-9559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOLLEY JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-450-9425