Provider Demographics
NPI:1790717981
Name:CLEVELAND, LILLIAN (RN)
Entity Type:Individual
Prefix:MISS
First Name:LILLIAN
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:IDA
Other - Middle Name:LILLIAN
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1525 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4224
Mailing Address - Country:US
Mailing Address - Phone:404-727-9532
Mailing Address - Fax:404-727-5349
Practice Address - Street 1:1525 CLIFTON RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-727-9532
Practice Address - Fax:404-727-5349
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN055742163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health