Healthcare Provider Details

I. General information

NPI: 1336193481
Provider Name (Legal Business Name): WOMEN'S SPECIALTY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL STREET SUITE 600
JACKSON MS
39202-1650
US

IV. Provider business mailing address

501 MARSHALL STREET SUITE 600
JACKSON MS
39202-1650
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-6540
  • Fax: 601-326-1501
Mailing address:
  • Phone: 601-948-6540
  • Fax: 601-326-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE G. FERGUSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 601-948-6540