Provider Demographics
NPI:1114526753
Name:CLIATT, JESSICA LEONOR (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEONOR
Last Name:CLIATT
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 BELL DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-2637
Mailing Address - Country:US
Mailing Address - Phone:912-856-6991
Mailing Address - Fax:
Practice Address - Street 1:960 JOHNSON FERRY RD STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-300-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN254137163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse