COTENNA D. CLARK (NPI# 1801401112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801401112 |
| Entity Type | Individual |
| Full Name | COTENNA D. CLARK |
| Other Name | COTENNA D GARDNER |
| Practice Address |
1857 Cameo Ct Tucker GA 30084-7002 |
| Practice Telephone | 6784851156 |
| Mailing Telephone | 6784851156 |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2020-09-14 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
RN231376 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
RN231376 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1857 CAMEO CT |
| City | TUCKER |
| State | GA |
| Zip Code | 30084-7002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609401355 | Excellent Medical Transport | Ambulance | 4378 Sentry Dr, Tucker, GA 30084 | 2020-03-03 |
| 1811468796 | Caleb Lee Ebbets | Physical Therapist | 1459 Montreal Road, Medical Office Building, Suite 301, Tucker, GA 30084 | 2018-12-17 |
| 1417436130 | Benjamin Han Wook Chong | Physical Therapist | 1460 Montreal Road East, Suite 300, Tucker, GA 30084 | 2018-08-13 |
| 1336659325 | Lavista Acupuncture and Herbal Medicine | Acupuncturist | 4915 Lavista Rd, Tucker, GA 30084 | 2017-10-04 |
| 1699294207 | Debrica Butler | Counselor | 1021 Oak Chase Dr., Apt C, Tucker, GA 30084 | 2017-09-14 |
| 1295264695 | Jolanta Wazgowska Hopkins | Social Worker | 4404 Idlewood Lane, Tucker, GA 30084 | 2017-06-08 |
| 1164956157 | Sage Dental Group of Georgia LLC | Dentist | 4320 Lavista Rd, Suite C119, Tucker, GA 30084 | 2017-04-17 |
| 1689107807 | Mashail Manzur | Podiatrist | 1460 Montreal Rd E, Ste 275, Tucker, GA 30084 | 2017-04-05 |
| 1053765578 | Jessica Spruyt | Speech-Language Pathologist | 3756 Lavista Rd Suite 104, Tucker, GA 30084 | 2016-04-21 |
| 1265802318 | Spine and Orthopedics of Atlanta, LLC | Clinic/Center | 1462 Montreal Rd Ste 218, Tucker, GA 30084 | 2015-10-01 |
| Find all providers in zip 30084 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164783080 | Susanna Hammontree | Nurse Practitioner | 1990 Lakeside Pkwy, Suite 170, Tucker, GA 30084-5884 | 2012-06-06 |
| 1518916998 | Chae Eun Lee | Nurse Practitioner | 1990 Lakeside Pkwy, Suite 170, Tucker, GA 30084-5884 | 2006-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235746009 | Jummai Folashade Akinrinmade | Nurse Practitioner | 5290 Hidden Valley Ln, Cumming, GA 30028-7024 | 2020-09-25 |
| 1396350997 | Ellen Allen | Nurse Practitioner | 8040 Highway 54, Sharpsburg, GA 30277-2112 | 2020-09-10 |
| 1588277867 | Saleta Anica Brogdon | Nurse Practitioner | 10 Muirfield Dr, Covington, GA 30016-6536 | 2020-08-26 |
| 1043828106 | Shonkeisha Byrd | Nurse Practitioner | 1160 Great River Pkwy, Lawrenceville, GA 30045-7015 | 2020-07-15 |
| 1558982272 | Irene Kamau | Nurse Practitioner | 3605 Glenbarrett Ln Ne, Marietta, GA 30066-8509 | 2020-05-05 |
| 1891324133 | Branette Young | Nurse Practitioner | 1120 Lehavre Ct, Hampton, GA 30228-3022 | 2020-04-08 |
| 1851938559 | Sandra Holloway | Nurse Practitioner | 607 Bethany St, Sparks, GA 31647-7139 | 2019-12-02 |
| 1013550508 | Monica Smart Mills | Nurse Practitioner | 8315 Champion Trl, Fairburn, GA 30213-4739 | 2019-10-28 |
| 1063053478 | Emily Elizabeth Adams | Nurse Practitioner | 887 W Marietta St Nw, Atlanta, GA 30318-5252 | 2019-10-07 |
| 1922661800 | Dorcus Healthcare Services LLC | Nurse Practitioner | 105 Greystone Dr, Guyton, GA 31312-5548 | 2019-04-17 |
| Find all providers with the same taxonomy | ||||
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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.