Provider Demographics
NPI:1306960794
Name:WURTTEMBERG, GINNY (CNM, MSN)
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:
Last Name:WURTTEMBERG
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 JOHNSON FERRY ROAD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-250-4447
Mailing Address - Fax:404-250-1359
Practice Address - Street 1:993 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 360
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-250-4447
Practice Address - Fax:404-250-1359
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife