Provider Demographics
NPI:1275543241
Name:WOMENS GENERATIONAL CARE OBSTETRICS & GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:WOMENS GENERATIONAL CARE OBSTETRICS & GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-259-4100
Mailing Address - Street 1:3950 NEW COVINGTON PIKE
Mailing Address - Street 2:#220
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2591
Mailing Address - Country:US
Mailing Address - Phone:901-259-4100
Mailing Address - Fax:901-259-4140
Practice Address - Street 1:3950 NEW COVINGTON PIKE
Practice Address - Street 2:#220
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2591
Practice Address - Country:US
Practice Address - Phone:901-259-4100
Practice Address - Fax:901-259-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3731493Medicaid
TN3731493Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER