Individual
CALLIE DENISE CLEGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1052 MAIN ST, PORTERDALE, GA 30014-3439
(404) 640-6042
Mailing address
1052 MAIN ST, PORTERDALE, GA 30014-3439
(404) 640-6042
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
174562
GA
Other
Enumeration date
10/28/2024
Last updated
10/28/2024
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