Provider Demographics
NPI:1679695233
Name:CORESSENCE INC
Entity type:Organization
Organization Name:CORESSENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-321-0079
Mailing Address - Street 1:103 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-5649
Mailing Address - Country:US
Mailing Address - Phone:910-321-0079
Mailing Address - Fax:910-321-0072
Practice Address - Street 1:103 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5649
Practice Address - Country:US
Practice Address - Phone:910-321-0079
Practice Address - Fax:910-321-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty