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General NPI Number Information
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NPI Number | 1558488163
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Entity Type | Organization
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Legal Business Name | CLAYTON MEDICAL SURGICAL
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6911 TARA BLVD # A
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City | JONESBORO
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State | GA
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Zip | 30236-1503
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Country | US
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Telephone | 770-477-8573
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Fax | 770-477-9045
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Provider Business Mailing Address
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Address Line | 6911 TARA BLVD # A
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City | JONESBORO
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State | GA
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Zip | 30236-1503
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Country | US
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Telephone | 770-477-8573
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Fax | 770-477-9045
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAMON R MARQUEZ
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Credential | M.D.
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Telephone | 770-477-8573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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