Healthcare Provider Details

I. General information

NPI: 1013258524
Provider Name (Legal Business Name): PLANNED PARENTHOOD SOUTHEAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 S 25TH AVE
HATTIESBURG MS
39401-7301
US

IV. Provider business mailing address

241 PEACHTREE ST NE STE 400
ATLANTA GA
30303-1423
US

V. Phone/Fax

Practice location:
  • Phone: 601-296-6001
  • Fax:
Mailing address:
  • Phone: 404-688-9305
  • Fax: 404-688-0621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA J GAGANIS
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 404-567-8354