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General NPI Number Information
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NPI Number | 1386365435
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Entity Type | Organization
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Legal Business Name | CLEAN CLINIC OF GEORGIA
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 7001 HODGSON MEMORIAL DR STE 5
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City | SAVANNAH
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State | GA
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Zip | 31406-2549
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Country | US
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Telephone | 912-777-3759
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Fax | 912-550-4526
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Provider Business Mailing Address
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Address Line | 7001 HODGSON MEMORIAL DR STE 5
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City | SAVANNAH
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State | GA
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Zip | 31406-2549
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Country | US
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Telephone | 912-777-3759
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Fax | 912-550-4526
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Authorized Official
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Title or Position | MANAGER
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Name | ERIC HAMMETT
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Credential | CRNA
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Telephone | 770-298-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LA0401X
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Taxonomy Name | Addiction Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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