Basic Information
| Provider Information | |||||||||
| NPI: | 1790336840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILREATH | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | LEEANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 OLD LOUISVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SOPERTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304579540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789433849 | ||||||||
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| Practice Location | |||||||||
| Address1: | MEADOWS REGIONAL MEDICAL CENTER | ||||||||
| Address2: | ONE MEADOWS PARKWAY | ||||||||
| City: | VIDALIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304740979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125355555 | ||||||||
| FaxNumber: | 9125355457 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2019 | ||||||||
| LastUpdateDate: | 04/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | RN239124 | GA | N | Other Service Providers | Midwife | 367A00000X | RN239124 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.