Organization
INNOVATIVE CLINICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN ROSS PHARMD (OWNER/AUTHORIZED OFFICIAL)
(912) 531-0095
Entity
Organization
Contact information
Practice address
4439 COUNTRY CLUB RD, STATESBORO, GA 30458-9188
(912) 489-7979
Mailing address
4439 COUNTRY CLUB RD, STATESBORO, GA 30458-9188
(912) 489-7979
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
01/25/2022
Last updated
02/18/2022
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