Active NPI
Clarice Whitlock Wasmuth, RN-CS, ANP
- Adult Health Nurse Practitioner
- Norcross, GA
National Provider Identifier
1740466622
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- RN113689
- Practice address
- 3720 Davinci CT
Suite 400
Norcross, GA 30092-7627 - Phone
- (770) 582-4186
- NPI assigned
- Jan 10, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN113689 | GA | |
| Adult Health Nurse Practitioner | 363LA2200X | RN113689 | GA | Primary |
Addresses
Primary practice location
3720 Davinci CT
Suite 400
Norcross, GA 30092-7627
Mailing address
3720 Davinci CT
Suite 400
Norcross, GA 30092-7627
Phone (770) 582-4186
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003146803A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN113689 | GA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437782400000",
"number": "1740466622",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3720 DAVINCI CT",
"address_2": "SUITE 400",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300927627",
"telephone_number": "770-582-4186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3720 DAVINCI CT",
"address_2": "SUITE 400",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300927627",
"telephone_number": "770-582-4186"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASMUTH",
"first_name": "CLARICE",
"middle_name": "WHITLOCK",
"name_prefix": "Mrs.",
"credential": "RN-CS, ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-01-10",
"last_updated": "2015-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "GA",
"license": "RN113689",
"primary": false
},
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "GA",
"license": "RN113689",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003146803A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Norcross, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.