Provider Demographics
NPI:1609880103
Name:CLIFTON, JAMES D (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 KITE RD
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-5771
Mailing Address - Country:US
Mailing Address - Phone:478-237-2144
Mailing Address - Fax:478-237-4538
Practice Address - Street 1:305 KITE RD
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-5771
Practice Address - Country:US
Practice Address - Phone:478-237-2144
Practice Address - Fax:478-237-4538
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000246386JMedicaid
GA01BDHRQMedicare ID - Type Unspecified
D29149Medicare UPIN