Healthcare Provider Details

I. General information

NPI: 1467499095
Provider Name (Legal Business Name): ANNA M CLINE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 OLD LAFAYETTE RD
FT OGLETHORPE GA
30742-3510
US

IV. Provider business mailing address

2009 OLD LAFAYETTE ROAD
FORT OGLETHORPE GA
30742-3510
US

V. Phone/Fax

Practice location:
  • Phone: 706-861-5950
  • Fax: 706-858-0475
Mailing address:
  • Phone: 706-861-5950
  • Fax: 706-858-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR050561
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN088929
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: