Provider Demographics
NPI:1972862654
Name:CLEMMONS, JEFFERY DEONTAI (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:DEONTAI
Last Name:CLEMMONS
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 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 MEDICAL CENTER DR
Practice Address - Street 2:2301 VUH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-7237
Practice Address - Country:US
Practice Address - Phone:615-936-1830
Practice Address - Fax:615-936-3412
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN51762207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program