Healthcare Provider Details

I. General information

NPI: 1851139232
Provider Name (Legal Business Name): COMMUNITY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 GIRARD ST STE 100
GAITHERSBURG MD
20877-3467
US

IV. Provider business mailing address

8665 GEORGIA AVE
SILVER SPRING MD
20910-3405
US

V. Phone/Fax

Practice location:
  • Phone: 888-792-8224
  • Fax:
Mailing address:
  • Phone: 301-495-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALISA BRIGHTLEY
Title or Position: LEAD CREDENTIALING SPECIALIST
Credential:
Phone: 240-297-6758