Individual
CLYDE TYRONE JACOB III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6325 HOSPITAL PKWY, JOHNS CREEK, GA 30097-5775
(678) 474-7000
Mailing address
5950 CABOTAGE RD, DULUTH, GA 30097-8475
(908) 397-2019
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01089636A
IN
207V00000X
Obstetrics & Gynecology Physician
1999591
NY
207V00000X
Obstetrics & Gynecology Physician
25MA09347700
NJ
207V00000X
Obstetrics & Gynecology Physician
Primary
81399
GA
207V00000X
Obstetrics & Gynecology Physician
C1-0025884
DE
207V00000X
Obstetrics & Gynecology Physician
ME162114
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02219496
—
NY
Enumeration date
08/09/2005
Last updated
12/14/2023
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