Provider Demographics
NPI:1477975597
Name:NELSON CLEMENTS DMD INC
Entity Type:Organization
Organization Name:NELSON CLEMENTS DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-242-5511
Mailing Address - Street 1:2310 N PATTERSON ST BLDG E
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2500
Mailing Address - Country:US
Mailing Address - Phone:229-242-5511
Mailing Address - Fax:
Practice Address - Street 1:2310 N PATTERSON ST BLDG E
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2500
Practice Address - Country:US
Practice Address - Phone:229-242-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9150305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service