Provider Demographics
NPI:1750491767
Name:CLOUSE, CARA MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:MICHELLE
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 PARKWAY DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1213
Mailing Address - Country:US
Mailing Address - Phone:404-522-6569
Mailing Address - Fax:404-522-8265
Practice Address - Street 1:320 PARKWAY DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1213
Practice Address - Country:US
Practice Address - Phone:404-522-6569
Practice Address - Fax:404-522-8265
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003886363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00159412OtherMEDICARE RAILROAD
775100OtherBCBS
GA100002426AMedicaid
GA202I978663OtherMEDICARE
775100OtherBCBS