Individual
CLARENCE JOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-9729
(706) 721-8507
Mailing address
1120 15TH ST STE BI-1056, AUGUSTA, GA 30912-0002
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
019888
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000155471C
—
GA
01
—
300022473
RR MEDICARE
GA
05
—
R19888
—
SC
Enumeration date
08/30/2006
Last updated
04/21/2020
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