Provider Demographics
NPI:1699737080
Name:CLOFINE, RICHARD JAY (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAY
Last Name:CLOFINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1867 INDEPENDENCE SQUARE
Mailing Address - Street 2:#155
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338
Mailing Address - Country:US
Mailing Address - Phone:770-390-0012
Mailing Address - Fax:770-604-9140
Practice Address - Street 1:1867 INDEPENDENCE SQUARE
Practice Address - Street 2:#155
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338
Practice Address - Country:US
Practice Address - Phone:770-390-0012
Practice Address - Fax:770-604-9140
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA031720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E58085Medicare UPIN