Provider Demographics
NPI:1447454426
Name:CLERK SURGICAL ASSISTING SERVICES
Entity type:Organization
Organization Name:CLERK SURGICAL ASSISTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLERK
Authorized Official - Suffix:
Authorized Official - Credentials:CFA
Authorized Official - Phone:770-254-1503
Mailing Address - Street 1:20 OZMORE ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1038
Mailing Address - Country:US
Mailing Address - Phone:770-254-1503
Mailing Address - Fax:
Practice Address - Street 1:20 OZMORE ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1038
Practice Address - Country:US
Practice Address - Phone:770-254-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty