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NPI Code Detail

MEDICARE: PENNY L CHAMPION CNM

MEDICARE: PENNY L CHAMPION 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
1367A00000XAdvanced Practice MidwifeR079412GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265425797
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENNY L CHAMPION CNM
Provider Business Mailing Address
First Line : 414 FIFTH AVENUE
Second Line :
City : ALBANY
State : GA
Zip : 31701
Country : US
Telephone Number : 229-883-4555
Fax Number : 229-888-0063
Provider Business Practice Location Address
First Line : 414 5TH AVE
Second Line :
City : ALBANY
State : GA
Zip : 31701-1976
Country : US
Telephone Number : 229-883-4555
Fax Number : 229-888-0063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 12/09/2016

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Directions to “ PENNY L CHAMPION CNM” Practice Location

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