Healthcare Provider Details

I. General information

NPI: 1376689901
Provider Name (Legal Business Name): CLINTON D. MCCORD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW SUITE 640
ATLANTA GA
30327-1610
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW SUITE 640
ATLANTA GA
30327-1610
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-0051
  • Fax: 678-420-7056
Mailing address:
  • Phone: 404-351-0051
  • Fax: 678-420-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number009548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: