Provider Demographics
NPI:1982679064
Name:CLEMENTS, FRANK DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:DAVID
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 DAN PROCTOR DR
Mailing Address - Street 2:STE 1400
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3894
Mailing Address - Country:US
Mailing Address - Phone:912-576-6355
Mailing Address - Fax:912-576-6393
Practice Address - Street 1:2060 DAN PROCTOR DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3894
Practice Address - Country:US
Practice Address - Phone:912-576-6355
Practice Address - Fax:912-576-6393
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003475363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100001115AMedicaid
GA97WCCJTMedicare ID - Type Unspecified
GA100001115AMedicaid