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NPI Code Detail

MEDICARE: DEWITT CLINTON ALFRED III MD

MEDICARE: DEWITT CLINTON ALFRED III MD
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
12084P0800XPsychiatry Physician42989GA

General Provider Information

NPI Number : 1659313955
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEWITT CLINTON ALFRED III MD
Provider Business Mailing Address
First Line : 831 FAIRWAYS CT STE A
Second Line :
City : STOCKBRIDGE
State : GA
Zip : 30281-7278
Country : US
Telephone Number : 770-389-1925
Fax Number : 912-437-9481
Provider Business Practice Location Address
First Line : 2900 CHAMBLEE TUCKER RD BLDG 16
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4148
Country : US
Telephone Number : 770-939-1288
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 01/31/2023

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