Provider Demographics
NPI:1336392059
Name:CLIFTON, SAMUEL (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5708 BARRINGTON RUN
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6103
Mailing Address - Country:US
Mailing Address - Phone:404-840-2310
Mailing Address - Fax:770-964-2356
Practice Address - Street 1:5708 BARRINGTON RUN
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6103
Practice Address - Country:US
Practice Address - Phone:404-840-2310
Practice Address - Fax:770-964-2356
Is Sole Proprietor?:No
Enumeration Date:2008-10-25
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist