Basic Information
| Provider Information | |||||||||
| NPI: | 1154789915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLAXTON | ||||||||
| FirstName: | TOYA | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | CSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8618 STONE CREEK CT | ||||||||
| Address2: | |||||||||
| City: | DOUGLASVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301351657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049143172 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11975 MORRIS RD | ||||||||
| Address2: | |||||||||
| City: | ALPHARETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300054419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703609916 | ||||||||
| FaxNumber: | 7703609937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2016 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.