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Organization
CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC
Active
Organization
CLEANSLATE MEDICAL GROUP OF CONNECTICUT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT HUTCHISON (CFO)
(615) 425-0220
Entity
Organization
Contact information
Practice address
85 GILLETT ST, HARTFORD, CT 06105-2630
(615) 425-0220
(413) 727-3619
Mailing address
8 CADILLAC DR STE 180, BRENTWOOD, TN 37027-5393
(615) 425-0220
(413) 727-3619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
12/09/2016
Last updated
03/23/2023
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