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DR. MACK H CLEMENTS MD

>> General Practice >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1255331351

Individual Registrant:
DR. MACK H CLEMENTS MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
211 EAST BROAD ST  PINE MOUNTAIN, GA 31822-0516 US
Tel: 706-663-2574  Fax: 706-663-5954

Contact information for business:
PO BOX 516  PINE MOUNTAIN, GA 31822-0516 US
Tel: 706-663-2574  Fax: 706-663-5954

Registration Information:
NPI: 1255331351
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N208D00000XAllopathic & Osteopathic Physicians
General Practice
GA11304
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
GA11304

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
00070452AGA05
00070452BGA05




HEALTH CARE JOBS GA - Page 1



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