1. Home
  2. Directory
  3. Georgia
  4. Forest Park
  5. Nurse Practitioner
  6. NPI Profile

CLINICA AGAVE CLINIC
NPI 1407091705
Nurse Practitioner - Family in Forest Park, GA

Active since December 16, 2008
4434 JONESBORO RD, FOREST PARK, GA 30297(404) 447-3444(404) 377-3445 Get Directions Write a Review

NPPES record last updated: December 16, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Clinica Agave Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CLINICA AGAVE CLINIC (NPI 1407091705) is a healthcare organization registered as a family in Forest Park, Georgia and active in the NPI registry since December 2008. The organization lists Judith T Chabot, Provider, as its authorized official.

NPPES Registry Identity

NPI1407091705
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameCLINICA AGAVE CLINIC
Location Address4434 JONESBORO RDForest Park, GA 30297-4313
Mailing Address4434 Jonesboro RdForest Park, GA 30297-4313 · (404) 447-3444 · Fax (404) 377-3445
Phone(404) 447-3444
Fax(404) 377-3445
Organization SubpartNo
Authorized OfficialJudith T ChabotProvider · (404) 447-3444
Enumeration DateDecember 16, 2008
✔ NPI 1407091705 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
4434 JONESBORO RD, Forest Park, GA 30297
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Clinica Agave Clinic's NPI number?

The NPI number for Clinica Agave Clinic is 1407091705. It was assigned to this organization in the NPPES registry on December 16, 2008.

Where is Clinica Agave Clinic located?

Clinica Agave Clinic is located at 4434 Jonesboro Rd, Forest Park, GA 30297. The listed phone number is (404) 447-3444.

What is Clinica Agave Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Clinica Agave Clinic was last updated on December 16, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.