Healthcare Provider Details

I. General information

NPI: 1841616653
Provider Name (Legal Business Name): CLEAR MEDICAL CONCEPTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 FOREST PKWY SUITE K
FOREST PARK GA
30297-6140
US

IV. Provider business mailing address

526 FOREST PKWY STE K
FOREST PARK GA
30297-6140
US

V. Phone/Fax

Practice location:
  • Phone: 770-545-2052
  • Fax:
Mailing address:
  • Phone: 770-545-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberPA004496
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number62629
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61157
License Number StateGA

VIII. Authorized Official

Name: MR. ANDREVIUS JEFFERSON
Title or Position: CHIEF OF OPERATIONS
Credential: PA-C
Phone: 770-545-2052