Lagniappe LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0666736 Issued in GA

Legal business name

LAGNIAPPE LLC

Practice address

1975 Highway 54 W
Suite 100
Fayetteville, GA 30214-4794

Phone

(770) 632-3730

Fax

(770) 632-3731

NPI assigned

Apr 12, 2013

Last updated

Apr 12, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anthony T Clavo Sr., M.D.

Title

President

Phone

(770) 632-3730

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1396188967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 HIGHWAY 54 W",
            "address_2": "SUITE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144794",
            "telephone_number": "770-632-3730",
            "fax_number": "770-632-3731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 HIGHWAY 54 W",
            "address_2": "SUITE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144794",
            "telephone_number": "770-632-3730",
            "fax_number": "770-632-3731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGNIAPPE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-12",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "CLAVO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-632-3730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "0666736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.