| Organization Name: | CLJ HEALTHCARE, LLC |
| NPI Number: | 1275781759 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NEDRA REGINA DODDS (PHYSICIAN/OWNER) |
| Mailing Address: | 6572 Highway 92 Suite 200 Acworth |
| State: | GA US |
| Postal Code: | 301027562 |
| Phone Number: | 7705913429 |
| Fax Number: | |
| NPI Enumeration Date: | 09/09/2008 |
| NPI Last Update Date: | 09/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 039170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |