Individual
CHARLI HICKS CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
367 ATHENS HWY STE 650, LOGANVILLE, GA 30052-7980
(706) 389-8941
(706) 389-8942
Mailing address
1100 WANDA CT, MONROE, GA 30655-8354
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
RN238981
GA
208100000X
Physical Medicine & Rehabilitation Physician
RN238981
GA
363LF0000X
Family Nurse Practitioner
Primary
RN238981
GA
Other
Enumeration date
01/21/2020
Last updated
05/08/2026
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