Healthcare Provider Details

I. General information

NPI: 1639073364
Provider Name (Legal Business Name): AMY CLARK DEVLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 475
SANDY SPRINGS GA
30342-4755
US

IV. Provider business mailing address

3605 HAMPSTEAD CT NW
KENNESAW GA
30144-7331
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6023
  • Fax:
Mailing address:
  • Phone: 678-977-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN274967
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: