Healthcare Provider Details

I. General information

NPI: 1912147661
Provider Name (Legal Business Name): CLINICAL SUPPORT SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE SUITE 417
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

303 PARKWAY DR NE SUITE 417
ATLANTA GA
30312-1212
US

V. Phone/Fax

Practice location:
  • Phone: 770-785-9201
  • Fax: 770-602-1603
Mailing address:
  • Phone: 770-785-9201
  • Fax: 770-602-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT D REDDING
Title or Position: PRESIDENT
Credential:
Phone: 770-785-9201