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NPI Code Detail

MEDICARE: JEFFERY DEONTAI CLEMMONS M.D.

MEDICARE: JEFFERY DEONTAI CLEMMONS M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207L00000XAnesthesiology Physician51762TN

General Provider Information

NPI Number : 1972862654
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY DEONTAI CLEMMONS M.D.
Provider Business Mailing Address
First Line : 3841 GREEN HILLS VILLAGE DR STE 200
Second Line :
City : NASHVILLE
State : TN
Zip : 37215-2691
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1211 MEDICAL CENTER DR
Second Line : 2301 VUH
City : NASHVILLE
State : TN
Zip : 37232-7237
Country : US
Telephone Number : 615-936-1830
Fax Number : 615-936-3412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2012
Last Update Date : 03/26/2022

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