Provider Demographics
NPI: | 1821613167 |
---|---|
Name: | CLELAND, GEORGE K |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GEORGE |
Middle Name: | K |
Last Name: | CLELAND |
Suffix: | |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 27 PINETREE CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | VALDOSTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31601-6256 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-215-5486 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1400 RIVER PL |
Practice Address - Street 2: | |
Practice Address - City: | BRASELTON |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30517-5600 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-870-0642 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2020-06-12 |
Last Update Date: | 2020-06-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 7363 | 2278P1006X, 2279C0205X, 2279E0002X, 2279G1100X, 2279P3900X |
MO | 2017031731 | 227900000X |
GA | 790 | 363A00000X |
MO | 2019027227 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2279P3900X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Neonatal/Pediatrics |
No | 2278P1006X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Pulmonary Function Technologist |
No | 227900000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | |
No | 2279C0205X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Critical Care |
No | 2279E0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | Emergency Care |
No | 2279G1100X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Registered | General Care |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |