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General NPI Number Information
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NPI Number | 1700929585
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Entity Type | Organization
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Legal Business Name | WOMEN'S HEALTHCARE OFFICE OF OBGYN
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1264 WESLEY DR SUITE 103
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City | MEMPHIS
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State | TN
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Zip | 38116-6400
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Country | US
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Telephone | 901-345-4640
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Fax | 901-399-7973
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Provider Business Mailing Address
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Address Line | PO BOX 40978
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City | MEMPHIS
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State | TN
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Zip | 38174-0978
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Country | US
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Telephone | 901-345-4640
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Fax | 901-399-7973
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Authorized Official
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Title or Position | PHYSICIAN
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Name | BRENDA M HARDY
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Credential | MD
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Telephone | 901-345-4640
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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 | MD020350
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License Number State | TN
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