MEDICARE: CLINTON PERKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor
2	172A00000X	Driver

General Provider Information

NPI Number	:	1093250268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINTON PERKINS

Provider Business Mailing Address
First Line	:	161 HAWK NEST CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 HAWK NEST CT
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1271
Country	:	US
Telephone Number	:	804-402-2735
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	12/27/2016

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Directions to “ CLINTON PERKINS ” Practice Location

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