Provider Demographics
NPI:1396094264
Name:PINKSTON, CLARENCE A
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:A
Last Name:PINKSTON
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 1:7742 SPALDING DR
Mailing Address - Street 2:115
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4207
Mailing Address - Country:US
Mailing Address - Phone:678-580-2587
Mailing Address - Fax:
Practice Address - Street 1:7742 SPALDING DR
Practice Address - Street 2:115
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4207
Practice Address - Country:US
Practice Address - Phone:678-580-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN147191163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty