Provider Demographics
NPI:1316548860
Name:CLANTON, COURTNEY GRACE (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:GRACE
Last Name:CLANTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:GRACE
Other - Last Name:HAYWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 N. CUTHBERT STREET
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3518
Mailing Address - Country:US
Mailing Address - Phone:229-758-4212
Mailing Address - Fax:229-758-2668
Practice Address - Street 1:209 N. CUTHBERT STREET
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3518
Practice Address - Country:US
Practice Address - Phone:229-758-4212
Practice Address - Fax:229-758-2668
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily