Individual
MRS. CLARICE WHITLOCK WASMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN-CS, ANP
Contact information
Practice address
3720 DAVINCI CT, SUITE 400, NORCROSS, GA 30092-7627
(770) 582-4186
Mailing address
3720 DAVINCI CT, SUITE 400, NORCROSS, GA 30092-7627
(770) 582-4186
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN113689
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN113689
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003146803A
—
GA
Enumeration date
01/10/2008
Last updated
07/25/2015
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