Organization
CLARKHOLDER CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KEETER (CBO MANAGER)
(706) 812-4206
Entity
Organization
Contact information
Practice address
303 SMITH ST, LAGRANGE, GA 30240-2745
(706) 882-8831
(706) 812-4079
Mailing address
303 SMITH ST, LAGRANGE, GA 30240-2745
(706) 882-8831
(706) 812-4079
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
416
GA
Other
Enumeration date
07/12/2006
Last updated
08/22/2020
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