Provider Demographics
NPI:1114068889
Name:VADEN, THEA ANGELA (CNM)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:ANGELA
Last Name:VADEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY ROAD
Mailing Address - Street 2:SUITE 1-11000 (ATTENTION DENISE)
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-271-3421
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVENUE
Practice Address - Street 2:ATHENS REGIONAL MIDWIFERY CLINIC
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2793
Practice Address - Country:US
Practice Address - Phone:706-475-5700
Practice Address - Fax:706-475-5718
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN044251176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN044251OtherGA NURSING LICENSE