Provider Demographics
NPI:1598812166
Name:ADAMS, CLARENCE LEE JR (RN)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:LEE
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 THISTLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2343
Mailing Address - Country:US
Mailing Address - Phone:770-645-0652
Mailing Address - Fax:
Practice Address - Street 1:10670 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8404
Practice Address - Country:US
Practice Address - Phone:770-814-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN146216163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator