MEDICARE: CLINICAL CONSULTING SERVICES

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	183500000X	Pharmacist	PHI-012266	GA

General Provider Information

NPI Number	:	1760682041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL CONSULTING SERVICES

Provider Business Mailing Address
First Line	:	410 CRESTWORTH XING
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5739
Country	:	US
Telephone Number	:	678-516-1424
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 CRESTWORTH XING
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-5739
Country	:	US
Telephone Number	:	678-516-1424
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DARRA M WALLER
Credential	:	BA, MA
Telephone Number	:	678-516-1424

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	06/17/2008

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