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General NPI Number Information
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NPI Number | 1407648819
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Entity Type | Individual
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Provider Name | JESSICA WACKERMANN CNM
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 833 CAMPBELL HILL ST NW STE 400
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City | MARIETTA
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State | GA
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Zip | 30060-1147
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Country | US
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Telephone | 770-528-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 409 CHRISTINA WAY
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City | ACWORTH
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State | GA
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Zip | 30102-1377
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Country | US
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Telephone | 678-641-5269
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 255120
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License Number State | GA
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