Provider Demographics
NPI:1851502926
Name:CLEMENTS, EMILY (DO)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402365
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2365
Mailing Address - Country:US
Mailing Address - Phone:866-391-6826
Mailing Address - Fax:239-596-2355
Practice Address - Street 1:2350 VANDERBILT BEACH RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2760
Practice Address - Country:US
Practice Address - Phone:239-348-4098
Practice Address - Fax:239-596-2355
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLOS10308207V00000X
MI5101016111207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL543XOtherMEDICARE PTAN