Active NPI
Mary Jane Cleghorn, RN
- Adult Psychiatric/Mental Health Registered Nurse
- Gainesville, GA
National Provider Identifier
1871099036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Psychiatric/Mental Health Registered Nurse
- License
- RN106126
- Practice address
- 5563 Concord Cir
Gainesville, GA 30507-8704 - Phone
- (770) 530-2137
- NPI assigned
- Apr 4, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Psychiatric/Mental Health Registered Nurse | 163WP0809X | RN106126 | GA | Primary |
Addresses
Primary practice location
5563 Concord Cir
Gainesville, GA 30507-8704
Mailing address
5563 Concord Cir
Gainesville, GA 30507-8704
Phone (770) 530-2137
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90M0619454 | 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)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN106126 | GA | MD | Adult Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1871099036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5563 CONCORD CIR",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305078704",
"telephone_number": "770-530-2137"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5563 CONCORD CIR",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305078704",
"telephone_number": "770-530-2137"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEGHORN",
"first_name": "MARY",
"middle_name": "JANE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-04",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0809X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
"state": "GA",
"license": "RN106126",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "90M0619454",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.