Healthcare Provider Details

I. General information

NPI: 1225557408
Provider Name (Legal Business Name): SOUTHERN WOMANS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD STE 201
HERMITAGE TN
37076-2056
US

IV. Provider business mailing address

102 HARTMAN DR BLDG G121
LEBANON TN
37087-2569
US

V. Phone/Fax

Practice location:
  • Phone: 615-391-0800
  • Fax: 615-391-0431
Mailing address:
  • Phone: 615-391-0800
  • Fax: 615-391-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: RUTH G SARGENT
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 615-391-0800