Healthcare Provider Details

I. General information

NPI: 1447800529
Provider Name (Legal Business Name): BETHANY ERBY CBS, CHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY BRANCH MIDWIFE

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1292 JEFFERSON AVE
EAST POINT GA
30344-2752
US

IV. Provider business mailing address

1292 JEFFERSON AVE
EAST POINT GA
30344-2752
US

V. Phone/Fax

Practice location:
  • Phone: 229-444-7200
  • Fax: 833-463-2197
Mailing address:
  • Phone: 229-444-7200
  • Fax: 833-463-2197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number014
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberB5645B811C
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: