Individual
PROF. CLINTON L BOOMGARDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
59 EXECUTIVE PARK SOUTH NE, SUITE 2098, ATLANTA, GA 30329-2208
(404) 778-7230
(404) 778-3835
Mailing address
59 EXECUTIVE PARK SOUTH NE, SUITE 2098, ATLANTA, GA 30329-2208
(404) 778-7230
(404) 778-3835
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2221
GA
Other
Enumeration date
09/02/2006
Last updated
07/08/2007
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