Healthcare Provider Details

I. General information

NPI: 1427155589
Provider Name (Legal Business Name): CORINA MAE FITCH L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 SECOND ROAD
SUMMERTOWN TN
38483
US

IV. Provider business mailing address

115 CREEKVIEW ROAD
SUMMERTOWN TN
38483
US

V. Phone/Fax

Practice location:
  • Phone: 305-308-5900
  • Fax: 786-515-9874
Mailing address:
  • Phone: 305-308-5900
  • Fax: 786-515-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW102
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number101
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: