1801825385 NPI number — MRS. JILL FUTCH WHITFIELD CNM

Table of content: MRS. JILL FUTCH WHITFIELD CNM (NPI 1801825385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801825385 NPI number — MRS. JILL FUTCH WHITFIELD CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITFIELD
Provider First Name:
JILL
Provider Middle Name:
FUTCH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITFIELD
Provider Other First Name:
JILL
Provider Other Middle Name:
FUTCH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801825385
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 MUSGROVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31411-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-598-1713
Provider Business Mailing Address Fax Number:
912-226-3268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1692 CHATHAM PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-629-6262
Provider Business Practice Location Address Fax Number:
912-226-3268
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  RN051676 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 217083747B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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