Provider Demographics
NPI:1952307563
Name:CLEM, ALISON J (PAC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:J
Last Name:CLEM
Suffix:
Gender:F
Credentials:PAC
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 14039
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0039
Mailing Address - Country:US
Mailing Address - Phone:706-863-9797
Mailing Address - Fax:706-860-7686
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:STE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1248
Practice Address - Country:US
Practice Address - Phone:205-933-7838
Practice Address - Fax:205-933-0951
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPA5834363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1021978547Medicare PIN