Healthcare Provider Details
I. General information
NPI: 1679898068
Provider Name (Legal Business Name): JENNIFER JEAN CLEMENTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 03/29/2010
Last Update Date: 03/02/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
20463 GEORGIA HIGHWAY 144
RICHMOND HILL GA
31324-5850
US
IV. Provider business mailing address
20463 GEORGIA HIGHWAY 144
RICHMOND HILL GA
31324-5850
US
V. Phone/Fax
- Phone: 770-580-9291
- Fax:
- Phone: 770-580-9291
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | TW-00030 |
| License Number State | KS |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 153170 |
| License Number State | FL |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 66171 |
| License Number State | AZ |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 2013026072 |
| License Number State | MO |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 34734 |
| License Number State | NE |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 0101270224 |
| License Number State | VA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 107277 |
| License Number State | MT |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 43914 |
| License Number State | AL |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 001553 |
| License Number State | CO |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 12703104-1205 |
| License Number State | UT |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | MD83503 |
| License Number State | SC |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 2049-320 |
| License Number State | WI |
| # 13 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2083B0002X |
| Taxonomy | Obesity Medicine (Preventive Medicine) Physician |
| License Number | 75663 |
| License Number State | GA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
