Provider Demographics
NPI:1407601826
Name:CLINTPLUS 4 GROUP
Entity Type:Organization
Organization Name:CLINTPLUS 4 GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:229-672-1248
Mailing Address - Street 1:450 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-3424
Mailing Address - Country:US
Mailing Address - Phone:229-672-1248
Mailing Address - Fax:
Practice Address - Street 1:450 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-3424
Practice Address - Country:US
Practice Address - Phone:229-672-1248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)