Individual
CHARLES MICHAEL CLEVENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
144 BILL CARRUTH PKWY, SUITE 4700, HIRAM, GA 30141-3818
(678) 453-5717
(770) 738-5476
Mailing address
5886 BROOKSTONE WALK NW, ACWORTH, GA 30101-8475
(770) 499-9118
(770) 792-8276
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT012150
GA
Other
Enumeration date
09/09/2015
Last updated
09/21/2016
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