Healthcare Provider Details

I. General information

NPI: 1801800941
Provider Name (Legal Business Name): CLARENCE J. HUNTER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NORMAN DORMINY DR SUITE A
FITZGERALD GA
31750-8855
US

IV. Provider business mailing address

119 NORMAN DORMINY DR STE A
FITZGERALD GA
31750-8855
US

V. Phone/Fax

Practice location:
  • Phone: 229-423-5437
  • Fax: 229-424-0868
Mailing address:
  • Phone: 229-423-5437
  • Fax: 229-424-0868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: