Provider Demographics
NPI:1508854811
Name:TRUESDELL, CLARA W (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:W
Last Name:TRUESDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:185 OLD PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2511
Mailing Address - Country:US
Mailing Address - Phone:678-937-0300
Mailing Address - Fax:781-464-2599
Practice Address - Street 1:185 OLD PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2511
Practice Address - Country:US
Practice Address - Phone:678-937-0300
Practice Address - Fax:781-464-2599
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034974207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000641253JMedicaid
GA000641253 F TO IMedicaid
GA39BDBZGMedicare ID - Type Unspecified
GA000641253 F TO IMedicaid