Provider Demographics
NPI:1740316470
Name:CORNERSTONE WOMEN'S CENTER, PLLC
Entity type:Organization
Organization Name:CORNERSTONE WOMEN'S CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-890-5559
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-0940
Mailing Address - Country:US
Mailing Address - Phone:662-890-5559
Mailing Address - Fax:662-893-8323
Practice Address - Street 1:6831 CRUMPLER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1927
Practice Address - Country:US
Practice Address - Phone:662-890-5559
Practice Address - Fax:662-893-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121942Medicaid
MS00121942Medicaid