Provider Demographics
NPI:1922471366
Name:DACULA MIDWIFERY SERVICES LLC
Entity Type:Organization
Organization Name:DACULA MIDWIFERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED NURSE MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE-GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:470-228-0842
Mailing Address - Street 1:2879 HERITAGE OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7082
Mailing Address - Country:US
Mailing Address - Phone:678-630-2669
Mailing Address - Fax:470-201-1179
Practice Address - Street 1:2879 HERITAGE OAKS CIR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7082
Practice Address - Country:US
Practice Address - Phone:678-630-2669
Practice Address - Fax:470-201-1179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185722261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing