Basic Information
| Provider Information | |||||||||
| NPI: | 1568049054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILES | ||||||||
| FirstName: | OLIVIA | ||||||||
| MiddleName: | MORRIS | ||||||||
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| OtherLastName: | MORRIS | ||||||||
| OtherFirstName: | OLIVIA | ||||||||
| OtherMiddleName: | CLAIRE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2500 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164500 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2550 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019841000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2021 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | GA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | MS | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | T-4432 | MS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.