Healthcare Provider Details

I. General information

NPI: 1679482475
Provider Name (Legal Business Name): JON MASON CLEMENTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 COLISEUM DR
MACON GA
31217-0104
US

IV. Provider business mailing address

211 WILD AZALEA DR
PERRY GA
31069-9445
US

V. Phone/Fax

Practice location:
  • Phone: 478-803-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018568
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: