MEDICARE: ALISON J CLEM 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
1	363AS0400X	Surgical Physician Assistant	PA5834	GA

General Provider Information

NPI Number	:	1952307563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON J CLEM PA.C

Provider Business Mailing Address
First Line	:	PO BOX 14039
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30919-0039
Country	:	US
Telephone Number	:	706-863-9797
Fax Number	:	706-860-7686

Provider Business Practice Location Address
First Line	:	2700 10TH AVE S
Second Line	:	STE 200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1248
Country	:	US
Telephone Number	:	205-933-7838
Fax Number	:	205-933-0951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/07/2011

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