Healthcare Provider Details

I. General information

NPI: 1821606237
Provider Name (Legal Business Name): CLINTON T GEORGE DNP, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/03/2024
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 E 3RD ST
DUNKIRK NY
14048-2239
US

IV. Provider business mailing address

107 INSTITUTE ST
JAMESTOWN NY
14701-6628
US

V. Phone/Fax

Practice location:
  • Phone: 716-363-6050
  • Fax: 833-974-1993
Mailing address:
  • Phone: 716-484-4334
  • Fax: 833-974-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: