Provider Demographics
NPI:1730213596
Name:SOUTHCREST WOMEN HEALTHCARE
Entity type:Organization
Organization Name:SOUTHCREST WOMEN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DABNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-349-4322
Mailing Address - Street 1:401SOUTH CREST CIRCLE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671
Mailing Address - Country:US
Mailing Address - Phone:662-349-4322
Mailing Address - Fax:
Practice Address - Street 1:401SOUTH CREST CIRCLE
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:662-349-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115267Medicaid