Provider Demographics
NPI:1386102119
Name:CLARIDY, DENISE EVETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:EVETTE
Last Name:CLARIDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WATERLACE WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5156
Mailing Address - Country:US
Mailing Address - Phone:813-857-5273
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2440
Practice Address - Country:US
Practice Address - Phone:404-351-5045
Practice Address - Fax:404-355-0691
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269752163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse