Healthcare Provider Details

I. General information

NPI: 1962456574
Provider Name (Legal Business Name): WOMANS CLINIC A PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 COATSLAND DR
JACKSON TN
38301-3948
US

IV. Provider business mailing address

244 COATSLAND DR
JACKSON TN
38301-3948
US

V. Phone/Fax

Practice location:
  • Phone: 731-422-4642
  • Fax: 731-422-2277
Mailing address:
  • Phone: 731-422-4642
  • Fax: 731-422-2277

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: MRS. CATHERINE J DILLON
Title or Position: BUSINESS OFFICE MGR
Credential:
Phone: 731-422-4642