Provider Demographics
NPI:1306891593
Name:CLIFTON, EMMETTE ROSS JR (DO)
Entity type:Individual
Prefix:DR
First Name:EMMETTE
Middle Name:ROSS
Last Name:CLIFTON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36302-0729
Mailing Address - Country:US
Mailing Address - Phone:334-793-2663
Mailing Address - Fax:334-836-2248
Practice Address - Street 1:345 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2053
Practice Address - Country:US
Practice Address - Phone:334-793-2663
Practice Address - Fax:334-836-2248
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO 3192084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000532364DMedicaid
AL159704Medicaid
AL1306891593OtherMEDICARE ID
GA000532364EMedicaid
AL164246Medicaid
AL511-47107OtherBCBS OF AL - RCC
AL511-52694OtherBCBS OF AL - ENTERPRISE
AL159086Medicaid
AL511-47106OtherBCBS OF AL - HEALTHWEST
GA000532364DMedicaid