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General NPI Number Information
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NPI Number | 1659313955
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Entity Type | Individual
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Provider Name | DEWITT CLINTON ALFRED III MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 2900 CHAMBLEE TUCKER RD BLDG 16
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City | ATLANTA
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State | GA
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Zip | 30341-4148
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Country | US
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Telephone | 770-939-1288
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Fax |
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Provider Business Mailing Address
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Address Line | 831 FAIRWAYS CT STE A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7278
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Country | US
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Telephone | 770-389-1925
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Fax | 912-437-9481
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 42989
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License Number State | GA
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