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General NPI Number Information
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NPI Number | 1740316470
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Entity Type | Organization
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Legal Business Name | CORNERSTONE WOMEN'S CENTER, PLLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6831 CRUMPLER BLVD SUITE 100
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-1927
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Country | US
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Telephone | 662-890-5559
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Fax | 662-893-8323
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Provider Business Mailing Address
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Address Line | PO BOX 1159
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-0940
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Country | US
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Telephone | 662-890-5559
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Fax | 662-893-8323
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES G RYAN JR.
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Credential | M.D.
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Telephone | 662-890-5559
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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 | 16676
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License Number State | MS
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