Provider Demographics
NPI:1538168224
Name:BUTLER, GEORGIA (CNM)
Entity type:Individual
Prefix:MS
First Name:GEORGIA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 COUNTY ROAD 3220
Mailing Address - Street 2:
Mailing Address - City:KEMPNER
Mailing Address - State:TX
Mailing Address - Zip Code:76539-3497
Mailing Address - Country:US
Mailing Address - Phone:254-547-8609
Mailing Address - Fax:254-286-7327
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:CRDAMC
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-288-8106
Practice Address - Fax:254-286-7327
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX449160176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR92880Medicare UPIN