Provider Demographics
NPI:1699879965
Name:C. V. CLOPTON, JR, MD, PC
Entity type:Organization
Organization Name:C. V. CLOPTON, JR, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/ BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREEN-CLOPTON
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:770-507-0112
Mailing Address - Street 1:PO BOX 90237
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30364-0237
Mailing Address - Country:US
Mailing Address - Phone:770-507-0112
Mailing Address - Fax:770-507-9450
Practice Address - Street 1:195 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2722
Practice Address - Country:US
Practice Address - Phone:770-507-0112
Practice Address - Fax:770-507-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6003Medicare ID - Type Unspecified