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General NPI Number Information
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NPI Number | 1740713569
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Entity Type | Individual
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Provider Name | KELLY KING CLEARY OD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2017
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 4159 MILL ST NE
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City | COVINGTON
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State | GA
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Zip | 30014-2546
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Country | US
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Telephone | 770-786-1234
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Fax | 770-385-0813
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Provider Business Mailing Address
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Address Line | 4159 MILL ST NE
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City | COVINGTON
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State | GA
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Zip | 30014-2546
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Country | US
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Telephone | 770-786-1234
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Fax | 770-385-0813
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT003007
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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