Provider Demographics
NPI:1306017249
Name:CLARA M PICAYO MD PC
Entity Type:Organization
Organization Name:CLARA M PICAYO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PICAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-926-2757
Mailing Address - Street 1:5570 BELLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2526
Mailing Address - Country:US
Mailing Address - Phone:770-926-2757
Mailing Address - Fax:770-926-2758
Practice Address - Street 1:5570 BELLS FERRY RD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2526
Practice Address - Country:US
Practice Address - Phone:770-926-2757
Practice Address - Fax:770-926-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58381208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty