Clemmons, John

Clemmons, John is an individual health care provider with primary practice located at 239 Methodist Blvd , Hattiesburg MS 39402-1297. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Clemmons, John can be contacted via phone (601) 296-2125.

Contact Information

Primary practice address
239 Methodist Blvd Hattiesburg MS 39402-1297
Phone: (601) 296-2125
Fax: (601) 268-8645
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 52911 Mississippi
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 52911 Mississippi
Behavioral Health & Social Service Providers / Psychologist 103T00000X 52911 Mississippi

Profile Details

NPI number 1104916766
LBN Legal business name Clemmons, John
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2006
Last updated Oct 8th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104916766 NPPES
Mississippi MEDICAID 03051508

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