Provider Demographics
NPI:1497831192
Name:MCTIER, CLYDE LUIS JR (ARNP-FNP)
Entity Type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:LUIS
Last Name:MCTIER
Suffix:JR
Gender:M
Credentials:ARNP-FNP
Other - Prefix:MR
Other - First Name:C.
Other - Middle Name:LUIS
Other - Last Name:MCTIER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:ARNP-FNP
Mailing Address - Street 1:2922 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-6528
Mailing Address - Country:US
Mailing Address - Phone:706-855-2767
Mailing Address - Fax:706-855-7077
Practice Address - Street 1:2922 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-6528
Practice Address - Country:US
Practice Address - Phone:706-855-2767
Practice Address - Fax:706-855-7077
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP06384Medicare UPIN