Provider Demographics
NPI:1699062786
Name:JEAN, CLYDE ANTONY (DC)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:ANTONY
Last Name:JEAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3079 CAMPBELLTON RD SW STE 205
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-5400
Mailing Address - Country:US
Mailing Address - Phone:404-344-0838
Mailing Address - Fax:404-344-0895
Practice Address - Street 1:3079 CAMPBELLTON RD SW STE 205
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-5400
Practice Address - Country:US
Practice Address - Phone:404-344-0838
Practice Address - Fax:404-344-0895
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor