Provider Demographics
NPI:1134382146
Name:CLEMMONS, TIMOTHY (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:CLEMMONS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6298 VETERANS PKWY
Mailing Address - Street 2:STE 5A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6258
Mailing Address - Country:US
Mailing Address - Phone:706-320-0927
Mailing Address - Fax:706-321-8167
Practice Address - Street 1:6298 VETERANS PKWY
Practice Address - Street 2:STE 5A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6258
Practice Address - Country:US
Practice Address - Phone:706-320-0927
Practice Address - Fax:706-321-8167
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009320225100000X, 2251E1300X
ALPTH61022251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH6102OtherALABAMA BOARD OF PHYSICAL THERAPY
GAPT009320OtherSTATE OF GEORGIA PHYSICAL THERAPY BOARD