Healthcare Provider Details

I. General information

NPI: 1538569975
Provider Name (Legal Business Name): CLIFFORD6, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4279 AUSTELL POWDER SPRINGS RD
POWDER SPRINGS GA
30127-2935
US

IV. Provider business mailing address

4279 AUSTELL POWDER SPRINGS RD
POWDER SPRINGS GA
30127-2935
US

V. Phone/Fax

Practice location:
  • Phone: 678-324-1237
  • Fax:
Mailing address:
  • Phone: 678-324-1237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. VINCENT EDWARD CLIFFORD
Title or Position: BUSINESS OWNER
Credential:
Phone: 678-361-4037