Provider Demographics
NPI:1073933867
Name:GEORGIA CLINICAL RESEARCH, LLC
Entity Type:Organization
Organization Name:GEORGIA CLINICAL RESEARCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:404-401-5751
Mailing Address - Street 1:15906 FARRINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1108
Mailing Address - Country:US
Mailing Address - Phone:813-979-0945
Mailing Address - Fax:813-866-7008
Practice Address - Street 1:2121 FOUNTAIN DR STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2900
Practice Address - Country:US
Practice Address - Phone:678-822-5582
Practice Address - Fax:678-822-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch