Provider Demographics
NPI:1770514440
Name:CLOPTON, JR, CHARLES V (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:V
Last Name:CLOPTON, JR
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 1:2611 N CLARK DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2342
Mailing Address - Country:US
Mailing Address - Phone:404-766-7518
Mailing Address - Fax:
Practice Address - Street 1:195 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2722
Practice Address - Country:US
Practice Address - Phone:770-507-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG80073Medicare UPIN
GA08BBQGJMedicare PIN