Provider Demographics
NPI:1588299325
Name:SOUTHWIND GYNECOLOGY & WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:SOUTHWIND GYNECOLOGY & WELLNESS CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-417-8551
Mailing Address - Street 1:3315 HACKS CROSS RD STE 109
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8935
Mailing Address - Country:US
Mailing Address - Phone:901-417-8551
Mailing Address - Fax:901-207-4563
Practice Address - Street 1:3315 HACKS CROSS RD STE 109
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8935
Practice Address - Country:US
Practice Address - Phone:901-417-8551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty