Individual
NYLA FAYE CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
804 DIXIE ST, CARROLLTON, GA 30117-4416
(770) 834-0606
(770) 834-1833
Mailing address
804 DIXIE ST, CARROLLTON, GA 30117-4416
(770) 834-0606
(770) 834-1833
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
RN065545 NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00803448A
—
GA
Enumeration date
11/21/2005
Last updated
01/06/2012
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