Basic Information
| Provider Information | |||||||||
| NPI: | 1174111231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITMER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | GILL | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3240 AVALON BLVD | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300136320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708601133 | ||||||||
| FaxNumber: | 7708601599 | ||||||||
| Practice Location | |||||||||
| Address1: | 3240 AVALON BLVD | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300136320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708601133 | ||||||||
| FaxNumber: | 7708601599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2021 | ||||||||
| LastUpdateDate: | 01/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | RN084160 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.