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General NPI Number Information
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NPI Number | 1366532038
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Entity Type | Organization
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Legal Business Name | COLUMBUS OBGYN SPECIALTY CENTER PLLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 425 HOSPITAL DR SUITE 5
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City | COLUMBUS
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State | MS
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Zip | 39705-1901
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Country | US
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Telephone | 662-240-0095
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Fax | 662-240-0096
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Provider Business Mailing Address
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Address Line | 425 HOSPITAL DR STE 5 P.O. BOX 8700
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City | COLUMBUS
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State | MS
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Zip | 39705-1938
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Country | US
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Telephone | 662-240-0095
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Fax | 662-240-0096
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Authorized Official
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Title or Position | MEMBER
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Name | DR. GREGORY WAYNE CHILDREY
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Credential | M.D.
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Telephone | 662-240-0095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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