Provider Demographics
NPI:1043547367
Name:WILEY, GEORGANNA (CNM, MSN, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:GEORGANNA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:CNM, MSN, WHNP
Other - Prefix:
Other - First Name:GEORGANNA
Other - Middle Name:
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1127 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404
Mailing Address - Country:US
Mailing Address - Phone:912-344-5066
Mailing Address - Fax:912-335-4494
Practice Address - Street 1:1127 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-344-5066
Practice Address - Fax:912-335-4494
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN161539367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife