Individual
ZACKARY CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 BEN BURTON CIR STE AANDB, BOGART, GA 30622-6851
(678) 942-6334
(706) 243-4760
Mailing address
342 JONES RD, JEFFERSON, GA 30549-3183
(678) 942-6334
(706) 757-3492
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
056780190
GA
171WV0202X
Vehicle Modifications Contractor
0567890190
GA
172A00000X
Driver
056780190
GA
Other
Enumeration date
11/08/2013
Last updated
07/10/2025
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