Healthcare Provider Details

I. General information

NPI: 1962033563
Provider Name (Legal Business Name): KEESHA MCCLOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 08/17/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PACES FERRY RD SE STE 750
ATLANTA GA
30339-4053
US

IV. Provider business mailing address

1205 JOSLIN PATH
DOUGLASVILLE GA
30134-3732
US

V. Phone/Fax

Practice location:
  • Phone: 678-368-2745
  • Fax:
Mailing address:
  • Phone: 470-471-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2020-12638
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number2020-12638
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number2020-12638
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: