Provider Demographics
NPI:1225300494
Name:KLEMM, DEREK ARTHUR (DO, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ARTHUR
Last Name:KLEMM
Suffix:
Gender:M
Credentials:DO, PHARMD
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 459
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:GA
Mailing Address - Zip Code:30628-0459
Mailing Address - Country:US
Mailing Address - Phone:706-788-3234
Mailing Address - Fax:
Practice Address - Street 1:396 HISTORIC HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-4348
Practice Address - Fax:706-754-0731
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47555183500000X
GA080289207Q00000X, 207QA0401X
FLOS14186207Q00000X
FLUO4670208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No183500000XPharmacy Service ProvidersPharmacist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080289OtherMEDICAL LICENSE