MEDICARE: JACKSON REGIONAL WOMENS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235155276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON REGIONAL WOMENS CENTER

Provider Business Mailing Address
First Line	:	72 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2070
Country	:	US
Telephone Number	:	731-668-4455
Fax Number	:	731-668-9007

Provider Business Practice Location Address
First Line	:	72 PHYSICIANS DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-2070
Country	:	US
Telephone Number	:	731-668-4455
Fax Number	:	731-668-9007

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MRS. BRENDA J HOWELL
Credential	:
Telephone Number	:	731-668-4455

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	08/22/2020

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Directions to “JACKSON REGIONAL WOMENS CENTER ” Practice Location

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