Provider Demographics
NPI:1326441114
Name:CLARKE, DEIRDRE PAQUITA
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:PAQUITA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DEIRDRE
Other - Middle Name:PAQUITA
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1005 BALDWIN ST SW. UNIT 9402
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1005 BALDWIN ST SW. UNIT 9402
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-996-6266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide