Organization
CLEANSLATE MEDICAL GROUP OF ARIZONA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA AMICK (AO)
(727) 798-8160
Entity
Organization
Contact information
Practice address
7725 N 43RD AVE STE 522, PHOENIX, AZ 85051-5771
(480) 729-8341
Mailing address
15 CENTURY BLVD STE 307, NASHVILLE, TN 37214-3692
(615) 425-0220
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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