Provider Demographics
NPI:1801800941
Name:HUNTER, CLARENCE J JR (MD)
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:J
Last Name:HUNTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NORMAN DORMINY DR STE A
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8855
Mailing Address - Country:US
Mailing Address - Phone:229-423-5437
Mailing Address - Fax:229-424-0868
Practice Address - Street 1:119 NORMAN DORMINY DR
Practice Address - Street 2:SUITE A
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8855
Practice Address - Country:US
Practice Address - Phone:229-423-5437
Practice Address - Fax:229-424-0868
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000305313FMedicaid
GA000305313NMedicaid