Provider Demographics
NPI:1548213887
Name:CLINIC FOR WOMEN OF CENTRAL MS
Entity Type:Organization
Organization Name:CLINIC FOR WOMEN OF CENTRAL MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-372-1541
Mailing Address - Street 1:1820 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204-3410
Mailing Address - Country:US
Mailing Address - Phone:601-372-1541
Mailing Address - Fax:601-373-5141
Practice Address - Street 1:1820 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3410
Practice Address - Country:US
Practice Address - Phone:601-372-1541
Practice Address - Fax:601-373-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty