Provider Demographics
NPI:1629450143
Name:CLARKSTON COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CLARKSTON COMMUNITY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAEES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-512-9675
Mailing Address - Street 1:3700 MARKET ST
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2653
Mailing Address - Country:US
Mailing Address - Phone:678-359-2060
Mailing Address - Fax:
Practice Address - Street 1:3700 MARKET ST
Practice Address - Street 2:SUITE E-1
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2653
Practice Address - Country:US
Practice Address - Phone:678-359-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2015-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care