Healthcare Provider Details

I. General information

NPI: 1952154767
Provider Name (Legal Business Name): ERIN WISOR WORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 E 4TH AVE
CORDELE GA
31015-3619
US

IV. Provider business mailing address

412 E 4TH AVE
CORDELE GA
31015-3619
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-1243
  • Fax: 229-273-1247
Mailing address:
  • Phone: 229-273-1243
  • Fax: 229-273-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberGAA-CNM003949
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: