Provider Demographics
NPI:1598068967
Name:CLINICAL SPECIALTIES, LLC
Entity Type:Organization
Organization Name:CLINICAL SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:706-855-1915
Mailing Address - Street 1:318 BASTON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2978
Mailing Address - Country:US
Mailing Address - Phone:706-855-1915
Mailing Address - Fax:
Practice Address - Street 1:318 BASTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2978
Practice Address - Country:US
Practice Address - Phone:706-855-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0086823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy