# CLEAN COLONIC FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003492158
- **Authorized official:** CAROLYN BERRY (OWNER)
- **Authorized official phone:** (480) 269-5575

## Contact information

- **Practice address:** 4744 E THUNDERBIRD RD STE 4, PHOENIX, AZ 85032-5577
- **Practice address phone:** (480) 269-5575
- **Mailing address:** 4744 E THUNDERBIRD RD STE 4, PHOENIX, AZ 85032-5577
- **Mailing address phone:** (480) 269-5575

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2021
- **Last updated:** 03/19/2021