Healthcare Provider Details

I. General information

NPI: 1871780775
Provider Name (Legal Business Name): CLINTON RESOURCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 LAKELAND PLZ
CUMMING GA
30040-2782
US

IV. Provider business mailing address

546 LAKELAND PLZ
CUMMING GA
30040-2782
US

V. Phone/Fax

Practice location:
  • Phone: 770-889-2014
  • Fax:
Mailing address:
  • Phone: 770-889-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES PURVIS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 770-889-2014