Healthcare Provider Details

I. General information

NPI: 1124635180
Provider Name (Legal Business Name): HIGHLAND CENTER FOR WOMEN'S HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 HIGHLAND PKWY STE 202
PICAYUNE MS
39466-5578
US

IV. Provider business mailing address

125 S 28TH AVE STE 326
HATTIESBURG MS
39401-7152
US

V. Phone/Fax

Practice location:
  • Phone: 601-358-9422
  • Fax:
Mailing address:
  • Phone: 601-288-1823
  • Fax: 601-288-4360

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: COURTNEY SHIELDS LOWRIMORE
Title or Position: CONTRACT ANALYST
Credential:
Phone: 601-288-1823