Provider Demographics
NPI:1467712737
Name:CLEMONS, TEEN EILEEN (RN)
Entity Type:Individual
Prefix:
First Name:TEEN
Middle Name:EILEEN
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:TOOMSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:31090-2344
Mailing Address - Country:US
Mailing Address - Phone:478-233-0309
Mailing Address - Fax:
Practice Address - Street 1:775 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:TOOMSBORO
Practice Address - State:GA
Practice Address - Zip Code:31090-2344
Practice Address - Country:US
Practice Address - Phone:478-233-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA182832163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine