Provider Demographics
NPI:1104591593
Name:MOLINEAUX, MARY LEAH (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEAH
Last Name:MOLINEAUX
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:200 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8504
Practice Address - Country:US
Practice Address - Phone:470-490-7200
Practice Address - Fax:770-276-7251
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN206154367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife