Provider Demographics
NPI:1366225716
Name:CLECKLER, PHLYTHIA CLARISSA
Entity type:Individual
Prefix:
First Name:PHLYTHIA
Middle Name:CLARISSA
Last Name:CLECKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5195 COTTER CT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1809
Mailing Address - Country:US
Mailing Address - Phone:470-691-9269
Mailing Address - Fax:
Practice Address - Street 1:5195 COTTER CT
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1809
Practice Address - Country:US
Practice Address - Phone:470-691-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide