Healthcare Provider Details

I. General information

NPI: 1982745170
Provider Name (Legal Business Name): SUSAN K ORTMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE MIDWIFERY DEPARTMENT
ATHENS GA
30606-2797
US

IV. Provider business mailing address

1199 PRINCE AVE MIDWIFERY DEPARTMENT
ATHENS GA
30606-2797
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN104264
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: