Provider Demographics
NPI:1578862421
Name:CLARKE-HALL, RENEE (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:CLARKE-HALL
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200429
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9008
Mailing Address - Country:US
Mailing Address - Phone:770-386-3011
Mailing Address - Fax:770-386-4966
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE BLDG A
Practice Address - Street 2:SUTE 101
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2175
Practice Address - Country:US
Practice Address - Phone:770-386-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180285363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics