Healthcare Provider Details

I. General information

NPI: 1033470984
Provider Name (Legal Business Name): INMED CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 RIDGECREST CIR
CLAYTON GA
30525-4186
US

IV. Provider business mailing address

PO BOX 5013
MONTGOMERY AL
36103-5013
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-0440
  • Fax:
Mailing address:
  • Phone: 334-386-0343
  • Fax: 334-386-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VICKI F LAWRENSON
Title or Position: COO
Credential:
Phone: 334-386-0343