# LARA CLEMENT, PLLC

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

## Provider details

- **NPI number:** 1902501083
- **Authorized official:** DR. LARA TEAL CLEMENT MD (MEDICAL DOCTOR)
- **Authorized official phone:** (601) 415-2711

## Contact information

- **Practice address:** 1308 HIGHWAY 51, MADISON, MS 39110-7205
- **Practice address phone:** (601) 853-4343
- **Mailing address:** 710 NEWITT VICK DR, VICKSBURG, MS 39183-8746
- **Mailing address phone:** (601) 415-2711
- **Mailing address fax:** (844) 579-0094

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/30/2023
- **Last updated:** 03/30/2023