PROF. CLINTON L BOOMGARDEN (NPI# 1316049000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316049000 |
| Entity Type | Individual |
| Full Name | PROF. CLINTON L BOOMGARDEN |
| Credential | PA |
| Practice Address |
59 Executive Park South Ne Suite 2098 Atlanta GA 30329-2208 |
| Practice Telephone | 4047787230 |
| Practice Fax Number | 4047783835 |
| Mailing Telephone | 4047787230 |
| Mailing Fax Number | 4047783835 |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2221 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
59 EXECUTIVE PARK SOUTH NE SUITE 2098 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30329-2208 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528025228 | John G Heller | Orthopaedic Surgery | 59 Executive Park South Ne, Ste 3000, Atlanta, GA 30329 | 2006-04-27 |
| 1346788387 | Tracy Chapin Ruska | Nurse Practitioner | 59 Executive Park South Ne, Suite 2092, Atlanta, GA 30329-2208 | 2017-02-10 |
| 1295197036 | Chelsea Denise Frost | Physical Medicine & Rehabilitation | 59 Executive Park South Ne, Atlanta, GA 30329-2208 | 2016-03-22 |
| 1609287085 | Hardeep Singh | Orthopaedic Surgery | 59 Executive Park South Ne, Atlanta, GA 30329-2208 | 2014-05-19 |
| 1720366339 | Preethi Ratakonda | Radiology | 59 Executive Park South Ne, Atlanta, GA 30329-2208 | 2011-07-31 |
| 1235450800 | Lisa Marie Resutek | Physical Therapist | 59 Executive Park South Ne, Atlanta, GA 30329-2208 | 2010-06-18 |
| 1669689865 | William Beckworth | Physical Medicine & Rehabilitation | 59 Executive Park South Ne, Atlanta, GA 30329-2208 | 2007-05-17 |
| 1134257686 | Denise Coultes | Nurse Practitioner | 59 Executive Park South Ne, Suite 2090, Atlanta, GA 30329-2208 | 2007-02-28 |
| 1588792014 | Andre J Roy | Nurse Practitioner | 59 Executive Park South Ne, Suite 2085, Atlanta, GA 30329-2208 | 2007-02-28 |
| 1205983178 | Nicholas David Fletcher | Orthopaedic Surgery | 59 Executive Park South Ne, Suite 2000, Atlanta, GA 30329-2208 | 2007-01-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871084111 | Inner Peace Counseling Services,llc | Counselor | 2801 Bufford Highway, Suite T-10, Atlanta, GA 30329 | 2018-05-22 |
| 1912409392 | Joie De Vivre Counseling and Therapy | Counselor | 2801 Buford Highway, Ne, Atlanta, GA 30329 | 2018-03-01 |
| 1902329105 | Barbara Dunbar | Psychologist | 1777 Northeast Expressway, #175, Atlanta, GA 30329 | 2017-07-19 |
| 1114449048 | Cricket Cheyenne Gullickson | Student in an Organized Health Care Education/Training Program | 1371 Briarvista Way Ne, Atlanta, GA 30329 | 2017-07-12 |
| 1902357866 | Carla Zimmerly | Nurse Practitioner | 1711 Tullie Circle, Atlanta, GA 30329 | 2016-10-17 |
| 1316490808 | Shahzad Ghori | Student in an Organized Health Care Education/Training Program | 1727 Druid Oaks Ne, Atlanta, GA 30329 | 2016-08-01 |
| 1023467768 | Ashley Elliott | Physician Assistant | 59 Executive Park, Atlanta, GA 30329 | 2016-06-03 |
| 1285096115 | Kimberley Fox | Internal Medicine | 1600 Clifton Rd Ne, Ms A-04, Cdc, Atlanta, GA 30329 | 2016-03-21 |
| 1275991648 | Mary Patricia Joyce | Internal Medicine | 1600 Clifton Road, E-47, Centers for Disease Control and Prevention, Atlanta, GA 30329 | 2016-02-01 |
| 1346656618 | Amelia Muniz Hernandez | Pediatrics | 1841 Clifton Rd Ne # 508, Atlanta, GA 30329 | 2014-07-08 |
| Find all providers in zip 30329 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659970408 | Laura N Gillespie | Physician Assistant | 1800 Howell Mill Rd., Suite 450, Atlanta, GA 30318 | 2020-10-22 |
| 1104433689 | Alexander Hartley Sprague | Physician Assistant | 244 13th St Ne Apt 208, Atlanta, GA 30309-3656 | 2020-09-28 |
| 1972117919 | Gregory Zimmerman | Physician Assistant | 2669 Fleur De Lis Pl, Atlanta, GA 30360-1409 | 2020-09-08 |
| 1083227821 | Jessica Haley Senft | Physician Assistant | 4274 Olde Mill Ln Ne, Atlanta, GA 30342-3400 | 2020-08-30 |
| 1801405758 | Philip Sangster | Physician Assistant | 3485 Greystone Cir, Atlanta, GA 30341-5854 | 2020-07-27 |
| 1114544525 | Nicole Warner | Physician Assistant | 1100 Faith Ave Se, Atlanta, GA 30316-1504 | 2020-07-01 |
| 1770108516 | Bita Ranjbari | Physician Assistant | 659 Auburn Ave Se, Suite 505, Atlanta, GA 30312 | 2020-06-08 |
| 1972125557 | Karen Charisse Forbes | Physician Assistant | 1600 Clifton Rd Ne # H16-1, Atlanta, GA 30329-4018 | 2020-05-17 |
| 1588290316 | Julie Teresa Lovelly | Physician Assistant | 1220 Caroline St Ne Ste A-230, Atlanta, GA 30307-2749 | 2020-03-12 |
| 1104463645 | Hannah Elyse Galvan | Physician Assistant | 550 Peachtree St Ne Bldg Rm3245a, Atlanta, GA 30308-2247 | 2019-12-03 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.