Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD000952 | GA |
Y | 222Z00000X | Podiatrist | POD000952 | GA |
NPI | 1003846718 |
---|---|
Provider Name | Dr. Suzette Andrean Clements |
First Address | Decatur, GA 30034-5039 |
Second Address | Decatur, GA 30034-5039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 10/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00963531A | (05) | GA |
U91377 | (02) | GA |