Provider Demographics
NPI:1699876243
Name:WESTDAHL, CLAIRE MCCAMMAN (CNM)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:MCCAMMAN
Last Name:WESTDAHL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JESSE HILL JR DR SE
Mailing Address - Street 2:EMORY UNIVERSITY GYN/OB DEPT., 4TH FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3033
Mailing Address - Country:US
Mailing Address - Phone:404-616-4901
Mailing Address - Fax:404-616-2904
Practice Address - Street 1:80 JESSE HILL JR DR SE # 26105
Practice Address - Street 2:GRADY HEALTH SYSTEM, GYN/OB CLINIC
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-4901
Practice Address - Fax:404-616-2904
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN120210367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
2413OtherACNM CERTIFICATION NUMBER
GA00634884AMedicaid
GARN120210OtherRN LICENSE-CNM
GA00634884AMedicaid