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General NPI Number Information
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NPI Number | 1821268236
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Entity Type | Organization
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Legal Business Name | WHITEHAVEN OB-GYN, P.C.
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 60 PHYSICIANS LN STE 2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6122
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Country | US
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Telephone | 662-349-7045
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Fax | 662-349-7048
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Provider Business Mailing Address
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Address Line | 60 PHYSICIANS LN STE 2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6122
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Country | US
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Telephone | 662-349-7045
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Fax | 662-349-7048
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROLYN GASKILL
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Credential | R.N.
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Telephone | 662-349-7045
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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 | 06684
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License Number State | MS
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