Provider Demographics
NPI:1902118334
Name:INTOWN MIDWIFERY, LLC
Entity type:Organization
Organization Name:INTOWN MIDWIFERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST/OFFICE LIAISON
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEREE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-770-0728
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:STE 520
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-622-9810
Mailing Address - Fax:404-265-2801
Practice Address - Street 1:5049 BENT TREE LOOP
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1538
Practice Address - Country:US
Practice Address - Phone:678-770-0728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184793363L00000X, 367A00000X
GARN029330367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00951651BMedicaid