Provider Demographics
NPI:1053598284
Name:THE CLINIC FOR ALL / LA CLINICA DE TODOS, LLC
Entity type:Organization
Organization Name:THE CLINIC FOR ALL / LA CLINICA DE TODOS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-559-5190
Mailing Address - Street 1:2548 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2329
Mailing Address - Country:US
Mailing Address - Phone:404-559-5190
Mailing Address - Fax:404-559-5189
Practice Address - Street 1:1795 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4149
Practice Address - Country:US
Practice Address - Phone:404-559-5190
Practice Address - Fax:404-559-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25399261QA0006X, 261QF0050X, 261QH0100X, 261QP3300X, 261QU0200X
GA025399261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care