Provider Demographics
NPI:1558488163
Name:CLAYTON MEDICAL SURGICAL
Entity Type:Organization
Organization Name:CLAYTON MEDICAL SURGICAL
Other - Org Name:CLAYTON MINOR EMERGENCY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-477-8573
Mailing Address - Street 1:6911 TARA BLVD # A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1503
Mailing Address - Country:US
Mailing Address - Phone:770-477-8573
Mailing Address - Fax:770-477-9045
Practice Address - Street 1:6911 TARA BLVD # A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1503
Practice Address - Country:US
Practice Address - Phone:770-477-8573
Practice Address - Fax:770-477-9045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA290529OtherUNITED HEALTHCARE
GAGRP1489Medicare ID - Type Unspecified