Provider Demographics
NPI:1871882225
Name:CLEAVER, NATHAN JEROME (DO)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:JEROME
Last Name:CLEAVER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:59 TIPTON DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1603
Mailing Address - Country:US
Mailing Address - Phone:770-800-3455
Mailing Address - Fax:770-450-8024
Practice Address - Street 1:105 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2381
Practice Address - Country:US
Practice Address - Phone:770-800-3455
Practice Address - Fax:770-800-3455
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008267207N00000X
GA76962207ND0101X, 207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003219114AMedicaid