Provider Demographics
NPI:1760682041
Name:CLINICAL CONSULTING SERVICES
Entity Type:Organization
Organization Name:CLINICAL CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DARRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:678-516-1424
Mailing Address - Street 1:410 CRESTWORTH XING
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5739
Mailing Address - Country:US
Mailing Address - Phone:678-516-1424
Mailing Address - Fax:
Practice Address - Street 1:410 CRESTWORTH XING
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5739
Practice Address - Country:US
Practice Address - Phone:678-516-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHI-012266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty