Provider Demographics
NPI:1558828657
Name:CLEMENTS, JAMES CONSTANTINE (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CONSTANTINE
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 FONTAINEBLEAU DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1213
Mailing Address - Country:US
Mailing Address - Phone:678-925-5654
Mailing Address - Fax:
Practice Address - Street 1:3240 N E EXPY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4003
Practice Address - Country:US
Practice Address - Phone:404-408-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant