Provider Demographics
NPI:1386365435
Name:CLEAN CLINIC OF GEORGIA
Entity type:Organization
Organization Name:CLEAN CLINIC OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMETT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:770-298-8333
Mailing Address - Street 1:7001 HODGSON MEMORIAL DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2549
Mailing Address - Country:US
Mailing Address - Phone:912-777-3759
Mailing Address - Fax:912-550-4526
Practice Address - Street 1:7001 HODGSON MEMORIAL DR STE 5
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2549
Practice Address - Country:US
Practice Address - Phone:912-777-3759
Practice Address - Fax:912-550-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty