Healthcare Provider Details

I. General information

NPI: 1225300494
Provider Name (Legal Business Name): DEREK ARTHUR KLEMM D.O., PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 03/10/2023
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 HISTORIC HIGHWAY 441 N
DEMOREST GA
30535
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-754-4348
  • Fax: 706-754-0731
Mailing address:
  • Phone: 706-788-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS47555
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number080289
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS14186
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberUO4670
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number080289
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: