Healthcare Provider Details

I. General information

NPI: 1851502926
Provider Name (Legal Business Name): EMILY CLEMENTS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 VANDERBILT BEACH RD SUITE 201
NAPLES FL
34109-2760
US

IV. Provider business mailing address

PO BOX 402365
ATLANTA GA
30384-2365
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4098
  • Fax: 239-596-2355
Mailing address:
  • Phone: 866-391-6826
  • Fax: 239-596-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberFLOS10308
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number5101016111
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: