Provider Demographics
NPI:1710428255
Name:AULT, CLAIRE (NP)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:AULT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 KITE RD
Mailing Address - Street 2:EMANUEL MEDICAL CENTER, ATTN DEBORAH DRIGGERS
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3231
Mailing Address - Country:US
Mailing Address - Phone:478-289-1303
Mailing Address - Fax:
Practice Address - Street 1:115 GILLIKIN ST
Practice Address - Street 2:
Practice Address - City:TWIN CITY
Practice Address - State:GA
Practice Address - Zip Code:30471-3989
Practice Address - Country:US
Practice Address - Phone:478-763-3036
Practice Address - Fax:478-763-3787
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner