Healthcare Provider Details

I. General information

NPI: 1114068889
Provider Name (Legal Business Name): THEA ANGELA VADEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVENUE ATHENS REGIONAL MIDWIFERY CLINIC
ATHENS GA
30606-2793
US

IV. Provider business mailing address

2727 PACES FERRY ROAD SUITE 1-11000 (ATTENTION DENISE)
ATLANTA GA
30339
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-5700
  • Fax: 706-475-5718
Mailing address:
  • Phone: 470-271-3421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN044251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: