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General NPI Number Information
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NPI Number | 1700336591
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Entity Type | Individual
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Provider Name | CLARA THOMAS BA,PP,CPS
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Gender | Female
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Dates
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Enumeration Date | 10/05/2016
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 6572 BAILEY RD
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City | BLACKSHEAR
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State | GA
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Zip | 31516-5246
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Country | US
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Telephone | 912-282-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 6572 BAILEY RD
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City | BLACKSHEAR
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State | GA
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Zip | 31516-5246
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Country | US
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Telephone | 912-282-4192
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2016 0D0247
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License Number State | GA
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