Provider Demographics
NPI:1194893057
Name:CLEMMONS, SAMUEL CLAY (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CLAY
Last Name:CLEMMONS
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 1:304 HADDON CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6242
Mailing Address - Country:US
Mailing Address - Phone:615-771-0114
Mailing Address - Fax:615-778-0209
Practice Address - Street 1:304 HADDON CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6242
Practice Address - Country:US
Practice Address - Phone:615-771-0114
Practice Address - Fax:615-778-0209
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN MD25854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN559915OtherOMNICARE PROVIDER ID
TN4103936OtherBCBS PROVIDER #
TN3084363Medicaid
TN000000167883OtherBETTER HEALTH
TN5000512OtherTLC PROVIDER #
TNF89312Medicare UPIN
TN3084363Medicaid