Healthcare Provider Details

I. General information

NPI: 1538154208
Provider Name (Legal Business Name): JOE F CLEMENTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST.
GAINESVILLE GA
30501
US

IV. Provider business mailing address

1000 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-7694
US

V. Phone/Fax

Practice location:
  • Phone: 770-535-3553
  • Fax: 770-533-8409
Mailing address:
  • Phone: 678-312-2418
  • Fax: 678-312-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number043580
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number043580
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number043580
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: