Provider Demographics
NPI:1891767448
Name:CLIFTON, MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:CLIFTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31207-1500
Mailing Address - Country:US
Mailing Address - Phone:478-301-2542
Mailing Address - Fax:
Practice Address - Street 1:1550 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31207-1500
Practice Address - Country:US
Practice Address - Phone:478-301-2542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061053207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001779460Medicaid
PAH12559Medicare UPIN
PA036536EB0Medicare ID - Type Unspecified