Healthcare Provider Details

I. General information

NPI: 1497795397
Provider Name (Legal Business Name): CLARENCE TERRELL ALFORD JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SMITH ST
LAGRANGE GA
30240-2745
US

IV. Provider business mailing address

303 SMITH ST
LAGRANGE GA
30240-2745
US

V. Phone/Fax

Practice location:
  • Phone: 706-882-8831
  • Fax: 706-812-4091
Mailing address:
  • Phone: 706-882-8831
  • Fax: 706-812-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44619
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: