Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 17509 | TN |
N | 207ND0900X | Dermatopathologist | 17509 | TN |
N | 207NS0135X | Procedural Dermatology | 17509 | TN |
NPI | 1104829308 |
---|---|
Provider Name | Donald Eugene Clemons |
First Address | Johnson City, TN 37604-3693 |
Second Address | Johnson City, TN 37604-3693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 01/06/2009 |