| Organization Name: | CLEMENTS PROFESSIONAL ASSOCIATION PINE MOUNTAIN |
| NPI Number: | 1801083134 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARTHA D CLEMENTS (VP SEC TRES AND MD) |
| Mailing Address: | 211 East Broad St Pine Mountain |
| State: | GA US |
| Postal Code: | 318220516 |
| Phone Number: | 7066632574 |
| Fax Number: | 7066635954 |
| NPI Enumeration Date: | 10/01/2007 |
| NPI Last Update Date: | 01/24/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |