Individual
MR. CLIFFORD BLANCHARD IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2700 NE EXPY NE STE B800, ATLANTA, GA 30345-1828
(404) 367-9111
(404) 367-9199
Mailing address
2700 NE EXPY NE STE B800, ATLANTA, GA 30345-1828
(404) 367-9111
(404) 367-9199
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
RPH024276
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH024276
GA BOARD OF PHARMACY
GA
Enumeration date
11/30/2020
Last updated
11/30/2020
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