Provider Demographics
NPI:1255547907
Name:CLEVENGER, CAROLYN KAY (NP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KAY
Last Name:CLEVENGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:KAY
Other - Last Name:SATTERFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1152 ALBEMARLE WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8142
Mailing Address - Country:US
Mailing Address - Phone:770-339-5806
Mailing Address - Fax:770-339-5806
Practice Address - Street 1:12 EXECUTIVE PARK DR NE
Practice Address - Street 2:SUITE 504
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2206
Practice Address - Country:US
Practice Address - Phone:404-778-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153941363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology