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General NPI Number Information
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NPI Number | 1013994060
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Entity Type | Organization
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Legal Business Name | THE WOMAN'S CLINIC OF TUPELO
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1512 MEDICAL PARK CIR
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City | TUPELO
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State | MS
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Zip | 38801-6560
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Country | US
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Telephone | 662-844-0867
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Fax | 662-844-7086
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Provider Business Mailing Address
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Address Line | 1512 MEDICAL PARK CIR
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City | TUPELO
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State | MS
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Zip | 38801-6560
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Country | US
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Telephone | 662-844-0867
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Fax | 662-844-7086
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Authorized Official
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Title or Position | OBGYN M.D.
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Name | MRS. LAURA J CRECELIUS
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Credential | M.D.
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Telephone | 662-844-0867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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