Provider Demographics
NPI:1629577846
Name:MCCLENTON, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:MCCLENTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 CHAPMAN CIR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2553
Mailing Address - Country:US
Mailing Address - Phone:404-201-9075
Mailing Address - Fax:
Practice Address - Street 1:859 CHAPMAN CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2553
Practice Address - Country:US
Practice Address - Phone:404-201-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle