Provider Demographics
NPI:1740062777
Name:GIRTMAN, ERICA (CNA)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GIRTMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-0228
Mailing Address - Country:US
Mailing Address - Phone:478-298-3179
Mailing Address - Fax:
Practice Address - Street 1:104 CLARKE DR
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-6036
Practice Address - Country:US
Practice Address - Phone:478-298-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028872520376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide