Individual
JILL M ANTISELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
550 PEACHTREE ST NE STE 1275, ATLANTA, GA 30308-2240
(404) 872-3121
(404) 872-3119
Mailing address
3495 PIEDMONT ROAD, NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305
(404) 364-7070
(470) 325-0193
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
RN164801
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
285718185A
WELLCARE
GA
05
—
285718185A
—
GA
Enumeration date
01/23/2007
Last updated
05/20/2024
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