Provider Demographics
NPI:1396744199
Name:CLAWSON, ELTON SHEROD (PA-C)
Entity type:Individual
Prefix:
First Name:ELTON
Middle Name:SHEROD
Last Name:CLAWSON
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 1:225 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3109
Mailing Address - Country:US
Mailing Address - Phone:704-972-1560
Mailing Address - Fax:704-335-8448
Practice Address - Street 1:110 LAKE CONCORD RD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2918
Practice Address - Country:US
Practice Address - Phone:704-792-2672
Practice Address - Fax:704-792-2674
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103656363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00016016OtherRAILROAD MEDICARE
P00016016OtherRAILROAD MEDICARE
NC2757122Medicare PIN
SCAA48946191Medicare PIN