Healthcare Provider Details

I. General information

NPI: 1295322980
Provider Name (Legal Business Name): ANNIE LADISIC WEBB CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOHNSON FY RD NE
SANDY SPRINGS GA
30342-1709
US

IV. Provider business mailing address

2451 ELLIJAY DR NE
BROOKHAVEN GA
30319-3439
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1137
  • Fax:
Mailing address:
  • Phone: 404-803-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number299296
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: