Healthcare Provider Details

I. General information

NPI: 1689239840
Provider Name (Legal Business Name): AIMEE A GAVETTE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S BROAD ST
THOMASVILLE GA
31792-6113
US

IV. Provider business mailing address

454 SMITH AVE
THOMASVILLE GA
31792-5535
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8800
  • Fax: 229-226-1660
Mailing address:
  • Phone: 229-584-2540
  • Fax: 229-226-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN271883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: