Organization
HERITAGE OBSTETRICS & GYNECOLGY CLINIC OF NM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG A WILLIS MD (PRESIDENT)
(662) 840-4010
Entity
Organization
Contact information
Practice address
606 BRUNSON DR, TUPELO, MS 38801-4947
(662) 840-4010
(662) 840-9038
Mailing address
606 BRUNSON DR, TUPELO, MS 38801-4947
(662) 840-4010
(662) 840-9038
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
207V00000X
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05453772
—
MS
Enumeration date
08/10/2006
Last updated
08/22/2020
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