MEDICARE: DR. CLARENCE A JUSTICE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	20969	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184614620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARENCE A JUSTICE MD

Provider Business Mailing Address
First Line	:	PO BOX 381468
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	589 GARFIELD ST STE 201
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-6301
Country	:	US
Telephone Number	:	662-680-5565
Fax Number	:	662-680-5654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	02/09/2026

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