Provider Demographics
NPI:1457459018
Name:ANDRES, JOAN GENEVIEVE (CNM)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:GENEVIEVE
Last Name:ANDRES
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:PO BOX 1117
Mailing Address - Street 2:10025 FORD AVENUE, SUITE 3-A
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-1117
Mailing Address - Country:US
Mailing Address - Phone:912-756-3404
Mailing Address - Fax:912-756-2156
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-355-9303
Practice Address - Fax:912-355-7704
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN086560367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0008597746BMedicaid
GA0008597746BMedicaid
598903Medicare UPIN