Provider Demographics
NPI:1477537934
Name:CLANTON, DOUGLAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W
Last Name:CLANTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:230 MARIETTA HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-479-4777
Mailing Address - Fax:770-479-9491
Practice Address - Street 1:230 MARIETTA HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-479-4777
Practice Address - Fax:770-479-9491
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2009-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA020676207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D29146Medicare UPIN