Provider Demographics
NPI:1225557408
Name:SOUTHERN WOMANS CARE
Entity Type:Organization
Organization Name:SOUTHERN WOMANS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:G
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-391-0800
Mailing Address - Street 1:102 HARTMAN DR BLDG G121
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2569
Mailing Address - Country:US
Mailing Address - Phone:615-391-0800
Mailing Address - Fax:615-391-0431
Practice Address - Street 1:5651 FRIST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2056
Practice Address - Country:US
Practice Address - Phone:615-391-0800
Practice Address - Fax:615-391-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT030270764OtherPTAN