Provider Demographics
NPI:1003846718
Name:CLEMENTS, SUZETTE ANDREAN (DPM,)
Entity Type:Individual
Prefix:DR
First Name:SUZETTE
Middle Name:ANDREAN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DPM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 FLAT SHOALS PKWY
Mailing Address - Street 2:SUITE # 301
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5039
Mailing Address - Country:US
Mailing Address - Phone:404-381-3600
Mailing Address - Fax:404-381-4900
Practice Address - Street 1:4535 FLAT SHOALS PKWY
Practice Address - Street 2:SUITE # 301
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5039
Practice Address - Country:US
Practice Address - Phone:404-381-3600
Practice Address - Fax:404-381-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000952213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00963531AMedicaid
GAU91377Medicare UPIN
GA4624670001Medicare NSC
GA48SCCKMMedicare PIN
GA00963531AMedicaid