1033648381 NPI number — ATLANTIA NESHAY CLEMENTS M. ED., SLP

Table of content: ATLANTIA NESHAY CLEMENTS M. ED., SLP (NPI 1033648381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033648381 NPI number — ATLANTIA NESHAY CLEMENTS M. ED., SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENTS
Provider First Name:
ATLANTIA
Provider Middle Name:
NESHAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M. ED., SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLEMENTS
Provider Other First Name:
ATLANTIA
Provider Other Middle Name:
NESHAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M. ED., SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1033648381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
76 HOSANNA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRIFFIN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30223-5806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-554-7035
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
424 W TAYLOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRIFFIN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30223-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-850-0571
Provider Business Practice Location Address Fax Number:
678-840-3638
Provider Enumeration Date:
06/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  PCET002377 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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