Individual provider Active NPI

Donald Eugene Clemons, M.D.

  • Dermatology Physician
  • Johnson City, TN
National Provider Identifier
1104829308
Registry record updated Jun 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
17509 Issued in TN
Practice address
1009 North State of Franklin Access Road
Johnson City, TN 37604-3693
Phone
(423) 929-7546
Fax
(423) 929-7968
NPI assigned
May 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 17509 TN Primary
Dermatopathology Physician 207ND0900X 17509 TN
Procedural Dermatology Physician 207NS0135X 17509 TN

Addresses

Primary practice location

1009 North State of Franklin Access Road
Johnson City, TN 37604-3693

Mailing address

1009 North State of Franklin Access Road
Johnson City, TN 37604-3693
Phone (423) 929-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1243814400000",
    "number": "1104829308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 NORTH STATE OF FRANKLIN ACCESS ROAD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043693",
            "telephone_number": "423-929-7546",
            "fax_number": "423-929-7968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 NORTH STATE OF FRANKLIN ACCESS ROAD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043693",
            "telephone_number": "423-929-7546",
            "fax_number": "423-929-7968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "DONALD",
        "middle_name": "EUGENE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2009-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TN",
            "license": "17509",
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TN",
            "license": "17509",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TN",
            "license": "17509",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.