| Mountain Laurel Medical Clinics, Llc | |
|
156 N Main St Clayton GA 30525-4266 | |
| (706) 782-0293 | |
| (706) 782-0118 |
| Full Name | Mountain Laurel Medical Clinics, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 156 N Main St, Clayton, Georgia |
| Authorized Official Name and Position | Michael Candio Caruso (OWNER) |
| Authorized Official Contact | 7067820293 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Laurel Medical Clinics, Llc 156 N Main St Clayton GA 30525-4266 Ph: (706) 782-0293 | Mountain Laurel Medical Clinics, Llc 156 N Main St Clayton GA 30525-4266 Ph: (706) 782-0293 |
| NPI Number | 1285926766 |
|---|---|
| Provider Enumeration Date | 05/03/2011 |
| Last Update Date | 07/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285926766 | NPI | - | NPPES |
| 000456178E | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 057558 (Georgia) | Primary |
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