Provider Demographics
NPI:1518498286
Name:WARE, BETHANY NORMAN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:NORMAN
Last Name:WARE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1280 WORTHINGTON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1753
Mailing Address - Country:US
Mailing Address - Phone:404-218-4741
Mailing Address - Fax:
Practice Address - Street 1:2060 DAN PROCTOR DR STE 1800
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4324
Practice Address - Country:US
Practice Address - Phone:912-510-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252390367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife