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General NPI Number Information
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NPI Number | 1831247345
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Entity Type | Organization
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Legal Business Name | SOUTHERN WOMEN'S CARE OBSTETRICS & GYNECOLOGY, PLLC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 67 KINGSWOOD DR STE A
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9647
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Country | US
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Telephone | 270-932-4525
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 127
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City | SUMMERSVILLE
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State | KY
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Zip | 42782-0127
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Country | US
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Telephone | 270-932-4525
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Fax | 270-932-2000
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Authorized Official
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Title or Position | ATTORNEY
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Name | MS. TERESA MARIE MARTIN
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Credential |
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Telephone | 270-932-4525
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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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