Organization
LAGNIAPPE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY T CLAVO SR. M.D. (PRESIDENT)
(770) 632-3730
Entity
Organization
Contact information
Practice address
1975 HIGHWAY 54 W, SUITE 100, FAYETTEVILLE, GA 30214-4794
(770) 632-3730
(770) 632-3731
Mailing address
1975 HIGHWAY 54 W, SUITE 100, FAYETTEVILLE, GA 30214-4794
(770) 632-3730
(770) 632-3731
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0666736
GA
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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