Basic Information
| Provider Information | |||||||||
| NPI: | 1487189072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLOSKEY | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 531 ROSELANE ST NW STE 710 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300606975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783313297 | ||||||||
| FaxNumber: | 6785817187 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 KENNESTONE HOSPITAL BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702815100 | ||||||||
| FaxNumber: | 6785817100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2017 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN209882 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1487189072 | 01 | GA | NPI NUMBER | OTHER |