Provider Demographics
NPI:1588284426
Name:BRASELTON CLINICAL SERVICES
Entity type:Organization
Organization Name:BRASELTON CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:K
Authorized Official - Last Name:SINOJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-714-0054
Mailing Address - Street 1:3841 ROXFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8507
Mailing Address - Country:US
Mailing Address - Phone:678-327-8650
Mailing Address - Fax:
Practice Address - Street 1:5745 OLD WINDER HWY STE G
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-1637
Practice Address - Country:US
Practice Address - Phone:678-327-8650
Practice Address - Fax:770-967-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty