Provider Demographics
NPI:1740926203
Name:CLEMMONS, CANDACE NICOLE (MD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:NICOLE
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ELBA HWY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36079-6020
Mailing Address - Country:US
Mailing Address - Phone:334-670-6726
Mailing Address - Fax:334-670-6731
Practice Address - Street 1:100 W LAKE PROFESSIONAL PARK STE 3
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:AL
Practice Address - Zip Code:36340-1200
Practice Address - Country:US
Practice Address - Phone:334-684-8905
Practice Address - Fax:334-684-8908
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine