Provider Demographics
NPI:1629368691
Name:CLEMONS, HEATHER LEE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WATERS AVENUE
Mailing Address - Street 2:PEDIATRIC RESIDENCY PROGRAM, MUMC
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-8193
Mailing Address - Fax:
Practice Address - Street 1:4608 JIMMY CARTER BLVD STE 7
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3758
Practice Address - Country:US
Practice Address - Phone:770-938-6966
Practice Address - Fax:770-938-6968
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA72295208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program