Provider Demographics
NPI:1619566023
Name:CLINE, CAROLYN ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ROSE
Last Name:CLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ROSE
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1931 COUNTY ROAD 561
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-6408
Mailing Address - Country:US
Mailing Address - Phone:423-715-4985
Mailing Address - Fax:
Practice Address - Street 1:135 N MEADOWS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4172
Practice Address - Country:US
Practice Address - Phone:423-745-9715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant