Provider Demographics
NPI:1053206136
Name:CLEGG, ANNE CARLTON
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CARLTON
Last Name:CLEGG
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROCKDELL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-4109
Mailing Address - Country:US
Mailing Address - Phone:205-490-4107
Mailing Address - Fax:
Practice Address - Street 1:8 ROCKDELL LN
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-4109
Practice Address - Country:US
Practice Address - Phone:205-490-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant