Provider Demographics
NPI:1033648381
Name:CLEMENTS, ATLANTIA NESHAY (M ED, SLP)
Entity Type:Individual
Prefix:
First Name:ATLANTIA
Middle Name:NESHAY
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:M ED, SLP
Other - Prefix:
Other - First Name:ATLANTIA
Other - Middle Name:NESHAY
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M ED, SLP
Mailing Address - Street 1:76 HOSANNA RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-5806
Mailing Address - Country:US
Mailing Address - Phone:678-554-7035
Mailing Address - Fax:
Practice Address - Street 1:424 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2818
Practice Address - Country:US
Practice Address - Phone:678-850-0571
Practice Address - Fax:678-840-3638
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET002377235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist