Healthcare Provider Details

I. General information

NPI: 1871537019
Provider Name (Legal Business Name): AMY L LEDFORD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 JESSE JEWELL PKWY SE SUITE D
GAINESVILLE GA
30501-3874
US

IV. Provider business mailing address

601 S ENOTA DR NE SUITE Q
GAINESVILLE GA
30501-2400
US

V. Phone/Fax

Practice location:
  • Phone: 678-450-4757
  • Fax: 678-450-4758
Mailing address:
  • Phone: 770-219-8420
  • Fax: 770-219-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN134376CNM
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: