Jacob, Clyde Tyrone
Jacob, Clyde Tyrone is an sole proprietor health care provider with primary practice located at 6325 Hospital Pkwy , Johns Creek GA 30097-5775. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Jacob, Clyde Tyrone can be contacted via phone (678) 474-7000.Contact Information
Primary practice address
6325 Hospital Pkwy
Johns Creek GA 30097-5775
Phone: (678) 474-7000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 01089636A | Indiana |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 1999591 | New York |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | ME162114 | Florida |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | C1-0025884 | Delaware |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 25MA09347700 | New Jersey |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 81399 | Georgia |
Profile Details
| NPI number | 1972504488 |
|---|---|
| LBN Legal business name | Jacob, Clyde Tyrone |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 9th, 2005 |
| Last updated | Dec 14th, 2023 - about last year |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972504488 | NPPES |
| New York | MEDICAID | 02219496 |
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