Provider Demographics
NPI:1477519106
Name:DRIGGERS, CLARKSON MCCLENDON JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CLARKSON
Middle Name:MCCLENDON
Last Name:DRIGGERS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 RIVER SOUND LN
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-0730
Mailing Address - Country:US
Mailing Address - Phone:706-531-9995
Mailing Address - Fax:
Practice Address - Street 1:751 HWY 53 EAST
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-0036
Practice Address - Country:US
Practice Address - Phone:706-216-1992
Practice Address - Fax:706-216-1998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist