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General NPI Number Information
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NPI Number | 1710844493
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Entity Type | Individual
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Provider Name | NISSY S CLEETUS
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Gender | Female
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 2310 PARKLAKE DR NE STE 228
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City | ATLANTA
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State | GA
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Zip | 30345-3070
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Country | US
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Telephone | 404-935-5900
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Fax | 678-252-2172
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Provider Business Mailing Address
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Address Line | 382 YELLOW SHOALS CT
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5136
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Country | US
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Telephone | 770-597-4808
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN188479
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License Number State | GA
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