Healthcare Provider Details

I. General information

NPI: 1184076762
Provider Name (Legal Business Name): FULL CIRCLE MIDWIFERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 HIGHWAY 304
HERNANDO MS
38632-8436
US

IV. Provider business mailing address

4716 HIGHWAY 304
HERNANDO MS
38632-8436
US

V. Phone/Fax

Practice location:
  • Phone: 901-828-8019
  • Fax: 662-449-0598
Mailing address:
  • Phone: 901-828-8019
  • Fax: 662-449-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number59
License Number StateTN

VIII. Authorized Official

Name: MRS. MELISSA PADGETT
Title or Position: MIDWIFE
Credential: CPM
Phone: 901-828-8019