Provider Demographics
NPI:1982745170
Name:ORTMAN, SUSAN K (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:ORTMAN
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 1:1199 PRINCE AVE
Mailing Address - Street 2:MIDWIFERY DEPARTMENT
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2797
Mailing Address - Country:US
Mailing Address - Phone:706-475-5700
Mailing Address - Fax:706-475-5718
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:MIDWIFERY DEPARTMENT
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-5700
Practice Address - Fax:706-475-5718
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN104264176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN104264OtherNURSING LICENSE