Provider Demographics
NPI:1588636898
Name:RANGE, LINDA (CNM)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:RANGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:JANE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1791 MULKEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1124
Mailing Address - Country:US
Mailing Address - Phone:770-732-5400
Mailing Address - Fax:770-944-0327
Practice Address - Street 1:1791 MULKEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1124
Practice Address - Country:US
Practice Address - Phone:770-732-5400
Practice Address - Fax:770-944-0327
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN113852367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife