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General NPI Number Information
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NPI Number | 1104000660
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Entity Type | Organization
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Legal Business Name | CLARA M PICAYO MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 5570 BELLS FERRY RD
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City | ACWORTH
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State | GA
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Zip | 30102-2526
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Country | US
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Telephone | 770-926-2757
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Fax | 770-926-2758
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Provider Business Mailing Address
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Address Line | 5570 BELLS FERRY RD
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City | ACWORTH
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State | GA
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Zip | 30102-2526
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Country | US
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Telephone | 770-926-2757
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Fax | 770-926-2758
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Authorized Official
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Title or Position | PHYSICIAN / PRESIDENT
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Name | CLARA M PICAYO
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Credential | MD
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Telephone | 770-926-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 058381
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License Number State | GA
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