Healthcare Provider Details

I. General information

NPI: 1770513897
Provider Name (Legal Business Name): CHERYL WILSON OWENS C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 02/25/2010
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: 706-226-0845
Mailing address:
  • Phone: 706-226-3373
  • Fax: 706-226-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR066880
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: