Provider Demographics
NPI:1467499095
Name:CLINE, ANNA M (CNM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:CLINE
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 1:2009 OLD LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3510
Mailing Address - Country:US
Mailing Address - Phone:706-861-5950
Mailing Address - Fax:706-858-0475
Practice Address - Street 1:2009 OLD LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3510
Practice Address - Country:US
Practice Address - Phone:706-861-5950
Practice Address - Fax:706-858-0475
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR050561367A00000X
TNRN088929367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00734896AMedicaid