Organization
CLARA M PICAYO MD PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLARA M PICAYO MD (PHYSICIAN / PRESIDENT)
(770) 926-2757
Entity
Organization
Contact information
Practice address
5570 BELLS FERRY RD, ACWORTH, GA 30102-2526
(770) 926-2757
(770) 926-2758
Mailing address
5570 BELLS FERRY RD, ACWORTH, GA 30102-2526
(770) 926-2757
(770) 926-2758
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
058381
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01149193
AMERIGROUP
GA
05
—
608406833B
—
GA
Enumeration date
12/19/2007
Last updated
01/28/2011
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