Organization
MOUNTAIN LAUREL MEDICAL CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL CANDIO CARUSO MD (OWNER)
(706) 782-0293
Entity
Organization
Contact information
Practice address
156 N MAIN ST, CLAYTON, GA 30525-4266
(706) 782-0293
(706) 782-0118
Mailing address
156 N MAIN ST, CLAYTON, GA 30525-4266
(706) 782-0293
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
057558
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000456178E
—
GA
Enumeration date
05/03/2011
Last updated
07/20/2011
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