Healthcare Provider Details

I. General information

NPI: 1073882262
Provider Name (Legal Business Name): JULIE DOTTERWEICH GUNBY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 ATKINSON RD STE 100
LAWRENCEVILLE GA
30043-5004
US

IV. Provider business mailing address

1000 HAWTHORNE AVE. SUITE G
ATHENS GA
30606
US

V. Phone/Fax

Practice location:
  • Phone: 678-775-0600
  • Fax: 678-377-5284
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN203047
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: