Provider Demographics
NPI:1780936252
Name:4KLOOR LLC
Entity type:Organization
Organization Name:4KLOOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-880-6879
Mailing Address - Street 1:1558 MARIETTA HYW
Mailing Address - Street 2:230
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:678-880-6879
Mailing Address - Fax:678-880-8834
Practice Address - Street 1:1558 MARIETTA HWY
Practice Address - Street 2:230
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3616
Practice Address - Country:US
Practice Address - Phone:678-880-6879
Practice Address - Fax:678-880-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA160312261Q00000X
261Q00000X
GA00658261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center