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NPI Code Detail

MEDICARE: TIERRA CLAYTON

MEDICARE: TIERRA CLAYTON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1720857741
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERRA CLAYTON
Provider Business Mailing Address
First Line : 124 W ML KING JR DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3226
Country : US
Telephone Number : 912-415-3144
Fax Number : 866-427-4321
Provider Business Practice Location Address
First Line : 124 W ML KING JR DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3226
Country : US
Telephone Number : 912-415-3144
Fax Number : 866-427-4321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2024
Last Update Date : 09/04/2024

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Directions to “ TIERRA CLAYTON ” Practice Location

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