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NPI Code Detail

MEDICARE: DR. NATHAN JEROME CLEAVER DO

MEDICARE: DR. NATHAN JEROME CLEAVER DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician76962GA
2207N00000XDermatology Physician2015008267MO
3207N00000XDermatology Physician76962GA
4207ND0900XDermatopathology Physician76962GA

General Provider Information

NPI Number : 1871882225
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN JEROME CLEAVER DO
Provider Business Mailing Address
First Line : 59 TIPTON DR
Second Line :
City : DAHLONEGA
State : GA
Zip : 30533-1603
Country : US
Telephone Number : 770-800-3455
Fax Number : 770-450-8024
Provider Business Practice Location Address
First Line : 105 PROFESSIONAL PARK DR
Second Line :
City : CUMMING
State : GA
Zip : 30040-2381
Country : US
Telephone Number : 770-800-3455
Fax Number : 770-800-3455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2011
Last Update Date : 12/02/2025

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