MEDICARE: THE CLINIC FOR ALL / LA CLINICA DE TODOS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0006X	Ambulatory Fertility Facility	25399	GA
2	261QF0050X	Non-Surgical Family Planning Clinic/Center	25399	GA
3	261QH0100X	Health Service Clinic/Center	25399	GA
4	261QP3300X	Pain Clinic/Center	25399	GA
5	261QU0200X	Urgent Care Clinic/Center	25399	GA
6	261QP2300X	Primary Care Clinic/Center	025399	GA

General Provider Information

NPI Number	:	1053598284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CLINIC FOR ALL / LA CLINICA DE TODOS, LLC

Provider Business Mailing Address
First Line	:	2548 LANCASTER DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-2329
Country	:	US
Telephone Number	:	404-559-5190
Fax Number	:	404-559-5189

Provider Business Practice Location Address
First Line	:	1795 WASHINGTON RD
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-4149
Country	:	US
Telephone Number	:	404-559-5190
Fax Number	:	404-559-5189

Authorized Official
Title or Position	:	AGENT
Name	:	MS. PATRICIA P FERGUSON
Credential	:
Telephone Number	:	404-559-5190

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	08/29/2012

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Directions to “THE CLINIC FOR ALL / LA CLINICA DE TODOS, LLC ” Practice Location

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