Provider Demographics
NPI:1821702887
Name:MCCLINTON, BILLY JACK III (CPHT)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:JACK
Last Name:MCCLINTON
Suffix:III
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 TUSCALOOSA ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36744-1562
Mailing Address - Country:US
Mailing Address - Phone:334-624-7151
Mailing Address - Fax:
Practice Address - Street 1:850 TUSCALOOSA ST STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1562
Practice Address - Country:US
Practice Address - Phone:334-624-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT54511183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician