Provider Demographics
NPI:1730578204
Name:CLEMENTS, ROY I (CPS)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:CLEMENTS
Suffix:I
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N 5TH STREET EXT
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-3753
Mailing Address - Country:US
Mailing Address - Phone:229-273-2091
Mailing Address - Fax:229-273-2022
Practice Address - Street 1:1335 N 5TH STREET EXT
Practice Address - Street 2:SUITE B
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-3753
Practice Address - Country:US
Practice Address - Phone:229-273-2091
Practice Address - Fax:229-273-2022
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker