Provider Demographics
NPI:1396813986
Name:GITTENS, CLAVEL A (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CLAVEL
Middle Name:A
Last Name:GITTENS
Suffix:
Gender:F
Credentials:FNP-BC
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:1250 HIGHWAY 54 W
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4545
Practice Address - Country:US
Practice Address - Phone:678-817-1117
Practice Address - Fax:678-817-0823
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN178900NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ73811Medicare UPIN
GA50BBLFMMedicare PIN