Provider Demographics
NPI:1487882916
Name:CLEMENTS, REBECCA BLACK (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:BLACK
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400A OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-751-6111
Mailing Address - Fax:770-772-6099
Practice Address - Street 1:3400A OLD MILTON PARKWAY
Practice Address - Street 2:SUITE 330
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-751-6111
Practice Address - Fax:770-772-6099
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2013-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003587208000000X
GA67547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics