Individual
DR. MACK H CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 EAST BROAD ST, PINE MOUNTAIN, GA 31822-0516
(706) 663-2574
(706) 663-5954
Mailing address
PO BOX 516, PINE MOUNTAIN, GA 31822-0516
(706) 663-2574
(706) 663-5954
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11304
GA
208D00000X
General Practice Physician
11304
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00070452A
—
GA
05
—
00070452B
—
GA
Enumeration date
07/29/2005
Last updated
10/14/2019
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