Provider Demographics
NPI:1174728364
Name:ROBERTA RESS, C.N.M., P.C.
Entity type:Organization
Organization Name:ROBERTA RESS, C.N.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESS
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:256-232-0636
Mailing Address - Street 1:108 SANDERS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2459
Mailing Address - Country:US
Mailing Address - Phone:256-232-0636
Mailing Address - Fax:256-232-1058
Practice Address - Street 1:108 SANDERS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2459
Practice Address - Country:US
Practice Address - Phone:256-232-0636
Practice Address - Fax:256-232-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1068016367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty