Provider Demographics
NPI:1023084829
Name:MOTTERSHAW, ANN M (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:MOTTERSHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E DOYLE ST
Mailing Address - Street 2:800 EAST DOYLE STREET
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2007
Mailing Address - Country:US
Mailing Address - Phone:706-886-7537
Mailing Address - Fax:
Practice Address - Street 1:800 E DOYLE ST
Practice Address - Street 2:800 EAST DOYLE STREET
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2007
Practice Address - Country:US
Practice Address - Phone:706-886-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0561492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI17213Medicare UPIN
GA30BDMHPMedicare ID - Type Unspecified