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NPI Code Detail

MEDICARE: JOHNATHON THOMAS CLIFTON

MEDICARE: JOHNATHON THOMAS CLIFTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11221905OTHERGANCCPA

General Provider Information

NPI Number : 1003775198
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNATHON THOMAS CLIFTON
Provider Business Mailing Address
First Line : 263 WESTON ST # 263
Second Line :
City : ROME CITY
State : IN
Zip : 46784-1018
Country : US
Telephone Number : 260-350-1326
Fax Number :
Provider Business Practice Location Address
First Line : 200 HIGH PARK AVE
Second Line :
City : GOSHEN
State : IN
Zip : 46526-4810
Country : US
Telephone Number : 312-599-7043
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ JOHNATHON THOMAS CLIFTON ” Practice Location

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