Provider Demographics
NPI:1447346887
Name:CLAY, KIMBERLY G (FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:CLAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:114 TOWNPARK DRIVE NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5802
Mailing Address - Country:US
Mailing Address - Phone:770-485-3723
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:790 CHURCH STREET, NE
Practice Address - Street 2:SUITE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8950
Practice Address - Country:US
Practice Address - Phone:770-953-3331
Practice Address - Fax:770-424-4480
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN140016NP363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I504757Medicare UPIN