Provider Demographics
NPI:1619541166
Name:CLINTON, GABRIEL THOMAS
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:THOMAS
Last Name:CLINTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4202
Mailing Address - Country:US
Mailing Address - Phone:803-775-6311
Mailing Address - Fax:803-778-5131
Practice Address - Street 1:237 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4202
Practice Address - Country:US
Practice Address - Phone:803-775-6311
Practice Address - Fax:803-778-5131
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86014MD208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics