MEDICARE: AMELIA HOLLAND CLEMMONS

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	101YS0200X	School Counselor	4562	NC

General Provider Information

NPI Number	:	1811193881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA HOLLAND CLEMMONS

Provider Business Mailing Address
First Line	:	3370 CLONINGER RD
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-8528
Country	:	US
Telephone Number	:	704-922-5979
Fax Number	:

Provider Business Practice Location Address
First Line	:	418 S CHURCH ST
Second Line	:
City	:	LOWELL
State	:	NC
Zip	:	28098-1806
Country	:	US
Telephone Number	:	704-824-2381
Fax Number	:

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

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/08/2007

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