Provider Demographics
NPI:1821580309
Name:CLEMENTS, ALSHICA HARPER
Entity Type:Individual
Prefix:
First Name:ALSHICA
Middle Name:HARPER
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3612
Mailing Address - Country:US
Mailing Address - Phone:229-854-5011
Mailing Address - Fax:
Practice Address - Street 1:1317 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3612
Practice Address - Country:US
Practice Address - Phone:229-854-5011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor