MEDICARE: MS. GEORGIA BUTLER 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	449160	TX

General Provider Information

NPI Number	:	1538168224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GEORGIA BUTLER CNM

Provider Business Mailing Address
First Line	:	2535 COUNTY ROAD 3220
Second Line	:
City	:	KEMPNER
State	:	TX
Zip	:	76539-3497
Country	:	US
Telephone Number	:	254-547-8609
Fax Number	:	254-286-7327

Provider Business Practice Location Address
First Line	:	36000 DARNALL LOOP
Second Line	:	CRDAMC
City	:	FT. HOOD
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:	254-288-8106
Fax Number	:	254-286-7327

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/09/2007

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