MEDICARE: CLARE IDEHEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	104775	GA
2	208000000X	Pediatrics Physician	104775	GA

General Provider Information

NPI Number	:	1740866292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARE IDEHEN MD

Provider Business Mailing Address
First Line	:	3896 PRINCETON LAKES WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5510
Country	:	US
Telephone Number	:	404-489-4444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3896 PRINCETON LAKES WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5510
Country	:	US
Telephone Number	:	404-489-4444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	06/22/2025

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Directions to “ CLARE IDEHEN MD” Practice Location

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