Provider Demographics
NPI:1992146120
Name:CLEMONS, JOSEPH JAMES (IDC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:CLEMONS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 BALLAHACK RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2499
Mailing Address - Country:US
Mailing Address - Phone:757-953-6273
Mailing Address - Fax:
Practice Address - Street 1:PSC 490
Practice Address - Street 2:#7
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96538-1600
Practice Address - Country:US
Practice Address - Phone:262-374-3183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman