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General NPI Number Information
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NPI Number | 1760682041
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Entity Type | Organization
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Legal Business Name | CLINICAL CONSULTING SERVICES
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 410 CRESTWORTH XING
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-5739
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Country | US
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Telephone | 678-516-1424
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Fax |
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Provider Business Mailing Address
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Address Line | 410 CRESTWORTH XING
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-5739
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Country | US
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Telephone | 678-516-1424
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DARRA M WALLER
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Credential | BA, MA
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Telephone | 678-516-1424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PHI-012266
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License Number State | GA
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