Provider Demographics
NPI:1790336840
Name:GILREATH, ANGEL LEEANN (CNM)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LEEANN
Last Name:GILREATH
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 1:1850 OLD LOUISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-9540
Mailing Address - Country:US
Mailing Address - Phone:678-943-3849
Mailing Address - Fax:
Practice Address - Street 1:MEADOWS REGIONAL MEDICAL CENTER
Practice Address - Street 2:ONE MEADOWS PARKWAY
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-0979
Practice Address - Country:US
Practice Address - Phone:912-535-5555
Practice Address - Fax:912-535-5457
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239124176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife