Doctor Name: | DR. MACK H CLEMENTS |
NPI Number: | 1255331351 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 11304 |
Business Practice Address: | 211 East Broad St Pine Mountain, GA - 318220516 |
Business Phone Number: | 7066632574 |
Business Fax Number: | 7066635954 |
Mailing Address: | Po Box 516, PINE MOUNTAIN |
State: | GA |
Postal Code: | 318220516 |
Phone Number: | 7066632574 |
Fax Number: | 7066635954 |
NPI Enumeration Date: | 07/29/2005 |
NPI Last Update Date: | 11/28/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 11304 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |