# MOUNTAINSIDE PEDIATRIC AND ADOLESCENT CLINIC, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518557073
- **Authorized official:** DR. VICTORIA L CLEMENTS DO (OWNER/PROVIDER)
- **Authorized official phone:** (706) 982-2721

## Contact information

- **Practice address:** 995 MAIN ST, ANDREWS, NC 28901-7087
- **Practice address phone:** (828) 321-3210
- **Practice address fax:** (828) 321-3211
- **Mailing address:** 995 MAIN ST, ANDREWS, NC 28901-7087
- **Mailing address phone:** (828) 321-3210
- **Mailing address fax:** (828) 321-3211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/19/2021
- **Last updated:** 05/25/2021