Provider Demographics
NPI:1073975967
Name:OTTENSMEYER, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OTTENSMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW STE 100B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1700
Mailing Address - Country:US
Mailing Address - Phone:404-352-3656
Mailing Address - Fax:404-350-5820
Practice Address - Street 1:275 COLLIER RD NW STE 100B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1700
Practice Address - Country:US
Practice Address - Phone:404-352-3656
Practice Address - Fax:404-350-5820
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA89594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program