Provider Demographics
NPI:1164567616
Name:CLEMENTE, ROSA ESTIPONIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:ESTIPONIA
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4208
Mailing Address - Country:US
Mailing Address - Phone:770-228-5187
Mailing Address - Fax:770-228-9837
Practice Address - Street 1:415 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4208
Practice Address - Country:US
Practice Address - Phone:770-228-5187
Practice Address - Fax:770-228-9837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024918207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology