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General NPI Number Information
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NPI Number | 1093225393
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Entity Type | Organization
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Legal Business Name | CLARK ATLANTA HEALTHCARE SERVICES
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 3201 ATLANTA INDUSTRIAL PARKWAY SUITE 302
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 678-791-9467
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 ATLANTA INDUSTRIAL PKWY NW STE 302
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City | ATLANTA
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State | GA
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Zip | 30331-1048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE HAM
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Credential |
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Telephone | 678-791-9467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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