MEDICARE: CLIFFORD6, LLC

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1538569975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIFFORD6, LLC

Provider Business Mailing Address
First Line	:	4279 AUSTELL POWDER SPRINGS RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2935
Country	:	US
Telephone Number	:	678-324-1237
Fax Number	:

Provider Business Practice Location Address
First Line	:	4279 AUSTELL POWDER SPRINGS RD
Second Line	:
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2935
Country	:	US
Telephone Number	:	678-324-1237
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	MR. VINCENT EDWARD CLIFFORD
Credential	:
Telephone Number	:	678-361-4037

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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