IndividualActive
Cotenna Clark
NPI 1801401112 · Gerontology Nurse Practitioner · Atlanta, GA
Provider details
- NPI number
- 1801401112
- Entity type
- Individual
- Primary specialty
- Gerontology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Female
- Sole proprietor
- Yes
- License
- RN231376 (GA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
57 Executive Park South Ne
Atlanta, GA 30329-2288
Phone: (404) 712-6929
Fax: (404) 712-0278
Approximate (ZIP-level) locationGet directions
Mailing address
1857 Cameo Ct
Tucker, GA 30084-7002
Registry dates
- Enumerated
- 2020-09-14
- Last updated
- 2025-12-11
- Certified
- 2025-12-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.