Provider Demographics
NPI:1265482418
Name:CLINE, LINA NMN (CRNA)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:NMN
Last Name:CLINE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PARK EAST DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3011
Mailing Address - Country:US
Mailing Address - Phone:678-523-4000
Mailing Address - Fax:
Practice Address - Street 1:120 PARK EAST DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3011
Practice Address - Country:US
Practice Address - Phone:678-523-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN139141367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA791785509BMedicaid
GA791785509BMedicaid
GAQ40148Medicare UPIN