=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598709263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS HEALTH SPECIALISTS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 05/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7800 WOLF TRAIL COVE
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-682-9222
-----------------------------------------------------
Fax | 901-682-9505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 372 DEPT 10
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38101-0372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-202-6120
-----------------------------------------------------
Fax | 901-202-6117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ERIC W GIBSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-373-8949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------