Organization
AGENCY FOR PERSONS WITH DISABILITIES
Active
Other names
Sunland Cox Medical Services - Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY L CLEMMONS (SUPERINTENDENT)
(850) 482-9222
Entity
Organization
Contact information
Practice address
3700 WILLIAMS DR, MARIANNA, FL 32446-7973
(850) 482-9222
(850) 718-0434
Mailing address
3700 WILLIAMS DR, MARIANNA, FL 32446-7973
(850) 482-9222
(850) 718-0434
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
261QH0100X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011996204
—
FL
Enumeration date
02/20/2009
Last updated
02/20/2009
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