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General NPI Number Information
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NPI Number | 1568499499
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Entity Type | Organization
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Legal Business Name | WOMENS CLINIC OF DYERSBURG, PLLC
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 305 E TICKLE ST SUITE B
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City | DYERSBURG
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State | TN
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Zip | 38024-3117
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Country | US
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Telephone | 731-286-1319
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Fax | 731-287-0420
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Provider Business Mailing Address
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Address Line | 1410 INDUSTRIAL PARK ROAD
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City | PARIS
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State | TN
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Zip | 38242
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Country | US
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Telephone | 800-887-4359
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Fax | 800-555-0119
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JUDY D WILSON
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Credential |
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Telephone | 731-286-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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