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NPI Code Detail

MEDICARE: JAMES CONSTANTINE CLEMENTS PA-C

MEDICARE:   JAMES CONSTANTINE CLEMENTS  PA-C
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 Assistant9134GA

General Provider Information

NPI Number : 1558828657
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES CONSTANTINE CLEMENTS PA-C
Provider Business Mailing Address
First Line : 2813 FONTAINEBLEAU DR
Second Line :
City : ATLANTA
State : GA
Zip : 30360-1213
Country : US
Telephone Number : 678-925-5654
Fax Number :
Provider Business Practice Location Address
First Line : 3240 N E EXPY NE
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4003
Country : US
Telephone Number : 404-408-9330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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Directions to “ JAMES CONSTANTINE CLEMENTS PA-C” Practice Location

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