Healthcare Provider Details

I. General information

NPI: 1811075815
Provider Name (Legal Business Name): NATIONAL WOMEN'S HEALTH ORGANIZATION OF JACKSON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 N STATE ST
JACKSON MS
39216-4202
US

IV. Provider business mailing address

3613 HAWORTH DR
RALEIGH NC
27609-7218
US

V. Phone/Fax

Practice location:
  • Phone: 601-366-2261
  • Fax: 601-362-5973
Mailing address:
  • Phone: 919-783-0444
  • Fax: 919-785-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number005
License Number StateMS

VIII. Authorized Official

Name: MS. SUSAN HILL
Title or Position: PRESIDENT
Credential:
Phone: 919-783-0444