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General NPI Number Information
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NPI Number | 1689017055
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Entity Type | Organization
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Legal Business Name | CLINTON'S COUNTRY RESTURANT
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Dates
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Enumeration Date | 04/16/2013
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 8007 LAGRANGE HWY
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City | GREENVILLE
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State | GA
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Zip | 30222-4530
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Country | US
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Telephone | 706-672-0200
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Fax | 706-672-2001
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Provider Business Mailing Address
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Address Line | 8007 LAGRANGE HWY
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City | GREENVILLE
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State | GA
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Zip | 30222-4530
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Country | US
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Telephone | 706-672-0200
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Fax | 706-672-2001
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Authorized Official
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Title or Position | OWNER
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Name | MR. CLINTON STROZIER
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Credential |
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Telephone | 706-672-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 70
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License Number State | GA
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