MEDICARE: SUMMER JOY OKIMOTO 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	367A00000X	Advanced Practice Midwife	AP119151	TX
2	367A00000X	Advanced Practice Midwife	0990974	CO
3	367A00000X	Advanced Practice Midwife	RN315907	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	828N92	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1710299862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER JOY OKIMOTO CNM

Provider Business Mailing Address
First Line	:	360 DOGWOOD TRL SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4653
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 DOGWOOD TRL SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4653
Country	:	US
Telephone Number	:	817-808-3379
Fax Number	:

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

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	08/13/2023

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