Provider Demographics
NPI:1487037883
Name:VAN ORDEN, AMY ELIZABETH (CNM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:VAN ORDEN
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 1:1525 CHATTANOOGA RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8379
Mailing Address - Country:US
Mailing Address - Phone:706-226-3373
Mailing Address - Fax:706-226-4256
Practice Address - Street 1:1525 CHATTANOOGA RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8379
Practice Address - Country:US
Practice Address - Phone:706-226-3373
Practice Address - Fax:706-226-4256
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003183677AMedicaid