Provider Demographics
NPI:1134793102
Name:CLINIC KLINIC
Entity type:Organization
Organization Name:CLINIC KLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOMINY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-875-9988
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW STE 510
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4849
Mailing Address - Country:US
Mailing Address - Phone:770-875-8889
Mailing Address - Fax:
Practice Address - Street 1:1750 POWDER SPRINGS RD SW STE 510
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4849
Practice Address - Country:US
Practice Address - Phone:770-875-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care