Provider Demographics
NPI:1497822274
Name:WOMANS GROUP OF MERIDIAN PLLC
Entity Type:Organization
Organization Name:WOMANS GROUP OF MERIDIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-482-1002
Mailing Address - Street 1:1221 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3926
Mailing Address - Country:US
Mailing Address - Phone:601-482-1002
Mailing Address - Fax:601-482-1190
Practice Address - Street 1:1221 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3926
Practice Address - Country:US
Practice Address - Phone:601-482-1002
Practice Address - Fax:601-482-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529803620OtherALABAMA MEDICAID
MS09014836Medicaid
MS09014836Medicaid