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General NPI Number Information
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NPI Number | 1376003483
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Entity Type | Individual
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Provider Name | CHARLES HENRY BREWERTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2019
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 2500 NORTH STATE STREET DEPARTMENT OF OBSTETRICS & GYNECOLOGY/MFM DIVISION
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City | JACKSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-815-9278
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Fax | 601-984-6773
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Provider Business Mailing Address
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Address Line | 2500 NORTH STATE STREET DEPARTMENT OF OBSTETRICS & GYNECOLOGY/MFM DIVISION
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City | JACKSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-815-9278
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Fax | 601-984-6773
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 31373
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License Number State | MS
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