Clayton State University

NPI #1962891556 in Morrow, Georgia

Provider Information

NPI Number: 1962891556
Entity Type: Organization
Organization Name: Clayton State University
Primary Specialty: Family Medicine
Enumeration Date: Jan 20, 2015
Last Updated: Jan 20, 2015

Practice Location

Address: 2000 CLAYTON STATE BLVD
City: Morrow
State: Georgia
ZIP Code: 30260-1250
Phone: (678) 466-4692

Authorized Official

Name: MOUZON BASS III
Title: AGENT
Phone: 18005559073

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine - Sports Medicine — Sports Medicine	207QS0010X
Family Medicine	207Q00000X	Primary

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