Provider Demographics
NPI:1225722929
Name:CLEMENS, PAUL SLADE JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:SLADE
Last Name:CLEMENS
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:929 HOLLY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7013
Mailing Address - Country:US
Mailing Address - Phone:919-762-2505
Mailing Address - Fax:
Practice Address - Street 1:210 TOWNE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8910
Practice Address - Country:US
Practice Address - Phone:919-859-3373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001013427363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant