Provider Demographics
NPI:1669909651
Name:DESOTO WOMENS CARE CENTER, PLLC
Entity type:Organization
Organization Name:DESOTO WOMENS CARE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:PEARCE
Authorized Official - Last Name:NORWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:916-501-7222
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-0089
Mailing Address - Country:US
Mailing Address - Phone:916-501-7222
Mailing Address - Fax:662-233-1180
Practice Address - Street 1:7600 AIRWAYS BLVD STE A
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-5138
Practice Address - Country:US
Practice Address - Phone:662-349-1000
Practice Address - Fax:662-233-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21158207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty