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General NPI Number Information
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NPI Number | 1225186992
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Entity Type | Organization
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Legal Business Name | CANTON ORTHOPAEDICS AND SPORTS MEDICINE, P.C.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 230 MARIETTA HWY SUITE 100
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City | CANTON
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State | GA
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Zip | 30114-2311
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Country | US
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Telephone | 770-479-4777
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Fax | 770-479-9491
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Provider Business Mailing Address
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Address Line | 230 MARIETTA HWY SUITE 100
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City | CANTON
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State | GA
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Zip | 30114-2311
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Country | US
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Telephone | 770-479-4777
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Fax | 770-479-9491
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Authorized Official
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Title or Position | CEO PHYSICIAN
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Name | DR. DOUGLAS W CLANTON
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Credential | MD
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Telephone | 770-479-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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