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General NPI Number Information
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NPI Number | 1255972030
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Entity Type | Individual
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Provider Name | JONATHAN BRUCE MCLEMORE CAA
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Gender | Male
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 247 S MAIN ST
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City | REIDSVILLE
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State | GA
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Zip | 30453-4605
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Country | US
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Telephone | 912-557-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1982 HONEY HILL CIR
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City | RIDGELAND
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State | SC
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Zip | 29936-6577
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Country | US
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Telephone | 843-368-8772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA549
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License Number State | FL
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