Most Relevant Information
Provider Data
| NPI Number: | 1003508755 |
| Provider Name: | EDWARD JACOB CLEMONS DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/22/2023 |
| Last Updated: | 05/22/2023 |
Provider Practice Location
1015 DONALD LEE HOLLOWELL PKWY NW
ATLANTA
GA
303186653
Practice Location Phone/Fax
| Phone: | 4045236571 |
| Fax: |
Provider Mailing Location
1015 DONALD LEE HOLLOWELL PKWY NW
ATLANTA
GA
303186653
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |