Individual
MARY JANE CLEGHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5563 CONCORD CIR, GAINESVILLE, GA 30507-8704
(770) 530-2137
Mailing address
5563 CONCORD CIR, GAINESVILLE, GA 30507-8704
(770) 530-2137
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
RN106126
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90M0619454
—
GA
Enumeration date
04/04/2018
Last updated
06/16/2018
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