Provider Demographics
NPI:1689239840
Name:GAVETTE, AIMEE A (CNM)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:A
Last Name:GAVETTE
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 1:454 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5535
Mailing Address - Country:US
Mailing Address - Phone:229-584-2540
Mailing Address - Fax:229-226-2036
Practice Address - Street 1:916 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6113
Practice Address - Country:US
Practice Address - Phone:229-226-8800
Practice Address - Fax:229-226-1660
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271883367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CNM05437OtherAMCB