Provider Demographics
NPI:1750853263
Name:CLEMMONS, FELICIA RENA (CMA)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:RENA
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 BEECH VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-2526
Mailing Address - Country:US
Mailing Address - Phone:404-971-6374
Mailing Address - Fax:678-398-2415
Practice Address - Street 1:814 BEECH VALLEY RD
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2526
Practice Address - Country:US
Practice Address - Phone:404-971-6374
Practice Address - Fax:678-398-2415
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide