Provider Demographics
NPI:1841616653
Name:CLEAR MEDICAL CONCEPTS LLC
Entity Type:Organization
Organization Name:CLEAR MEDICAL CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREVIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:770-545-2052
Mailing Address - Street 1:526 FOREST PKWY STE K
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6140
Mailing Address - Country:US
Mailing Address - Phone:770-545-2052
Mailing Address - Fax:
Practice Address - Street 1:526 FOREST PKWY
Practice Address - Street 2:SUITE K
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6140
Practice Address - Country:US
Practice Address - Phone:770-545-2052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPA004496146M00000X
GA62629207PE0004X
GA61157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, IntermediateGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty