Provider Demographics
NPI:1043211758
Name:PALMER, CLEMMIE III (MD)
Entity Type:Individual
Prefix:
First Name:CLEMMIE
Middle Name:
Last Name:PALMER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252026
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36125-2026
Mailing Address - Country:US
Mailing Address - Phone:334-280-3230
Mailing Address - Fax:334-280-3272
Practice Address - Street 1:3090 WOODLEY RD STE A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-3190
Practice Address - Country:US
Practice Address - Phone:334-280-3230
Practice Address - Fax:334-280-3272
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL200712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20071OtherMEDICAL LICENSE
AL51099544OtherFED BCBS
AL274116OtherVALUE OPTIONS/UPS SOLUTIONS
AL51077444OtherBCBS OF ALABAMA
00150005325OtherUNITED HEALTHCARE
AL529803110Medicaid
ALBP5015892OtherDEA
ALG63374Medicare UPIN
00150005325OtherUNITED HEALTHCARE