Healthcare Provider Details

I. General information

NPI: 1487037883
Provider Name (Legal Business Name): AMY ELIZABETH VAN ORDEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CHATTANOOGA RD
DALTON GA
30720-8379
US

IV. Provider business mailing address

1525 CHATTANOOGA RD
DALTON GA
30720-8379
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-3373
  • Fax: 706-226-4256
Mailing address:
  • Phone: 706-226-3373
  • Fax: 706-226-4256

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: