Organization Name: | INMED CLINICAL SERVICES LLC |
NPI Number: | 1356602205 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | VICKI F LAWRENSON (COO) |
Mailing Address: | 773 N Main St Clayton |
State: | GA US |
Postal Code: | 305254257 |
Phone Number: | 7067824233 |
Fax Number: | |
NPI Enumeration Date: | 06/06/2012 |
NPI Last Update Date: | 06/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |