Callie Denise Clegg, RN
Individual provider Active NPI Registered Nurse · Porterdale, GA
NPI 1073335592 · NPPES record last updated Oct 28, 2024
Key facts
- NPI
- 1073335592
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 174562 (GA)
- Practice address
- 1052 Main St
Porterdale, GA 30014-3439 - Phone
- (404) 640-6042
- NPI assigned
- Oct 28, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 174562 | GA | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 174562 | GA | Yes |
Addresses
Primary practice location
1052 Main St
Porterdale, GA 30014-3439
Mailing address
1052 Main St
Porterdale, GA 30014-3439
Phone (404) 640-6042
Other providers in Porterdale, GA
- Michael M. Allen Jr.
- Adam B Arlt
- Maurice Medical
- Pandora Antoinette Rhodes
- Corrina Michelle Schmierer
- Tina Starks
All providers in Porterdale, GA · Registered Nurse in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.