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General NPI Number Information
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NPI Number | 1518478023
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Entity Type | Individual
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Provider Name | CATHLEEN ANN CLEARY M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2017
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Last Update Date | 10/24/2017
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Provider Practice Location Address
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Address Line | 106 JULEE EMILYN DRIVE
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City | BONAIRE
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State | GA
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Zip | 31005
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Country | US
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Telephone | 404-906-6140
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Fax | 478-922-6122
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Provider Business Mailing Address
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Address Line | 1745 PHOENIX BLVD SUITE 240
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City | ATLANTA
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State | GA
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Zip | 30349
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Country | US
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Telephone | 404-507-7100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 50096
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License Number State | GA
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