Healthcare Provider Details

I. General information

NPI: 1871694414
Provider Name (Legal Business Name): ANNA KATHARINE SMILLIE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE SMILLIE CNM

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE # 26105 GRADY HEALTH SYSTEM, GYN/OB CLINIC
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

69 JESSE HILL JR DR SE EMORY UNIVERSITY GYN/OB DEPT., 4TH FLOOR
ATLANTA GA
30303-3033
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4898
  • Fax: 404-616-2904
Mailing address:
  • Phone: 404-616-4898
  • Fax: 404-616-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN103800
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: