Healthcare Provider Details

I. General information

NPI: 1306960794
Provider Name (Legal Business Name): GINNY WURTTEMBERG CNM, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 JOHNSON FERRY RD NE SUITE 360
ATLANTA GA
30342-1620
US

IV. Provider business mailing address

993 JOHNSON FERRY ROAD SUITE 360
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-4447
  • Fax: 404-250-1359
Mailing address:
  • Phone: 404-250-4447
  • Fax: 404-250-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: