Provider Demographics
NPI:1457566374
Name:CLEMENTS, JAMES WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WESLEY
Last Name:CLEMENTS
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 1:38 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9034
Mailing Address - Country:US
Mailing Address - Phone:601-355-3835
Mailing Address - Fax:601-355-4830
Practice Address - Street 1:664 S STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-5611
Practice Address - Country:US
Practice Address - Phone:601-355-3835
Practice Address - Fax:601-355-4830
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10763171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider