Healthcare Provider Details

I. General information

NPI: 1932154176
Provider Name (Legal Business Name): ANDREA M HARGRAVES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S BROAD ST UNIT B-2
THOMASVILLE GA
31792-6113
US

IV. Provider business mailing address

PO BOX 1479
THOMASVILLE GA
31799-1479
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8800
  • Fax: 229-226-8232
Mailing address:
  • Phone: 229-226-8800
  • Fax: 229-226-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN148927
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: