Provider Demographics
NPI:1689017055
Name:CLINTON'S COUNTRY RESTURANT
Entity Type:Organization
Organization Name:CLINTON'S COUNTRY RESTURANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:STROZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-672-0200
Mailing Address - Street 1:8007 LAGRANGE HWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30222-4530
Mailing Address - Country:US
Mailing Address - Phone:706-672-0200
Mailing Address - Fax:706-672-2001
Practice Address - Street 1:8007 LAGRANGE HWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:GA
Practice Address - Zip Code:30222-4530
Practice Address - Country:US
Practice Address - Phone:706-672-0200
Practice Address - Fax:706-672-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care