Healthcare Provider Details

I. General information

NPI: 1962423046
Provider Name (Legal Business Name): SANDERS CLINIC FOR WOMEN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 S MADISON ST
TUPELO MS
38801-6309
US

IV. Provider business mailing address

1041 S MADISON ST
TUPELO MS
38801-6309
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-8754
  • Fax:
Mailing address:
  • Phone: 662-844-8754
  • Fax:

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: RHONDA KELLY
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-844-6295