MEDICARE: CAROL A GOURLEY CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	RN096387	GA

General Provider Information

NPI Number	:	1023069820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A GOURLEY CNM

Provider Business Mailing Address
First Line	:	1365 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-7402
Fax Number	:	404-778-4819

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2225
Country	:	US
Telephone Number	:	404-686-3643
Fax Number	:	404-778-4819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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Directions to “ CAROL A GOURLEY CNM” Practice Location

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