Basic Information
| Provider Information | |||||||||
| NPI: | 1306960794 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WURTTEMBERG | ||||||||
| FirstName: | GINNY | ||||||||
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| Credential: | CNM, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 993 JOHNSON FERRY ROAD | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
| FaxNumber: | 4042501359 | ||||||||
| Practice Location | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
| FaxNumber: | 4042501359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 09/19/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.