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General NPI Number Information
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NPI Number | 1588490239
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Entity Type | Individual
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Provider Name | GRACE WELLIVER CPM-TN
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Gender | Female
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 208 E MADISON AVE
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City | ATHENS
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State | TN
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Zip | 37303-3646
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Country | US
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Telephone | 423-252-4555
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Fax | 423-370-1799
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Provider Business Mailing Address
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Address Line | PO BOX 121
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City | ATHENS
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State | TN
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Zip | 37371-0121
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Country | US
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Telephone |
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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 | 170
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License Number State | TN
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