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General NPI Number Information
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NPI Number | 1447454426
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Entity Type | Organization
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Legal Business Name | CLERK SURGICAL ASSISTING SERVICES
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20 OZMORE ST
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City | NEWNAN
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State | GA
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Zip | 30263-1038
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Country | US
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Telephone | 770-254-1503
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Fax |
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Provider Business Mailing Address
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Address Line | 20 OZMORE ST
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City | NEWNAN
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State | GA
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Zip | 30263-1038
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Country | US
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Telephone | 770-254-1503
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALTER L CLERK
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Credential | CFA
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Telephone | 770-254-1503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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