Healthcare Provider Details

I. General information

NPI: 1790336840
Provider Name (Legal Business Name): ANGEL LEEANN GILREATH CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEADOWS REGIONAL MEDICAL CENTER ONE MEADOWS PARKWAY
VIDALIA GA
30474-0979
US

IV. Provider business mailing address

1850 OLD LOUISVILLE RD
SOPERTON GA
30457-9540
US

V. Phone/Fax

Practice location:
  • Phone: 912-535-5555
  • Fax: 912-535-5457
Mailing address:
  • Phone: 678-943-3849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN239124
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN239124
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: