Basic Information
| Provider Information | |||||||||
| NPI: | 1669543856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDSEY | ||||||||
| FirstName: | CLIFFORD | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 BRANDYWINE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303415540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
| FaxNumber: | 7704889479 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 S ENOTA DR NE STE 400 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2006 | ||||||||
| LastUpdateDate: | 01/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 200401529 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2080P0202X | 059459 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 059459 | 01 | GA | GA COMPOSITE BOARD OF MEDICAL EXAMINERS | OTHER | BL9069471 | 01 | GA | DEA | OTHER | 200401529 | 01 | NC | NORTH CAROLINA MEDICAL BOARD | OTHER |