Provider Demographics
NPI:1366677304
Name:PERIMETER INSITUTE FOR CLINICAL RESEARCH, INC.
Entity Type:Organization
Organization Name:PERIMETER INSITUTE FOR CLINICAL RESEARCH, INC.
Other - Org Name:PICR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:HONG
Authorized Official - Last Name:MARGESON
Authorized Official - Suffix:SR
Authorized Official - Credentials:RD
Authorized Official - Phone:770-986-3885
Mailing Address - Street 1:9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 126
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-986-3885
Mailing Address - Fax:770-986-3887
Practice Address - Street 1:9 DUNWOODY PARK
Practice Address - Street 2:SUITE 126
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-986-3885
Practice Address - Fax:770-986-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000845133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty