Active NPI
Clyde Lee Clem IV, PT
- Physical Therapist
- Marietta, GA
National Provider Identifier
1255625125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 010069
- Practice address
- 3934 Hillsman LN
Marietta, GA 30062-8724 - Phone
- (770) 733-9707
- NPI assigned
- Jun 8, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 010069 | GA | Primary |
Addresses
Primary practice location
3934 Hillsman LN
Marietta, GA 30062-8724
Mailing address
3934 Hillsman LN
Marietta, GA 30062-8724
Phone (770) 733-9707
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 010069 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307491200000",
"number": "1255625125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3934 HILLSMAN LN",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300628724",
"telephone_number": "770-733-9707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3934 HILLSMAN LN",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300628724",
"telephone_number": "770-733-9707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEM",
"first_name": "CLYDE",
"middle_name": "LEE",
"name_suffix": "IV",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-08",
"last_updated": "2011-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "010069",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
- Kimberly G Clay, FNP-BC
- Clear Care Accident and Injury, LLC (Clear Care Accident and Injury)
- Clear Spine Chiropractic LLC
- Clearbrook Counseling LLC
- Roger Cleckley, M.A.
- Emily Paris Clements, FNP-C
- Larry Clements, MD
- Tiara Shyrese Clemmons, BCABA
- Crystal Rae Clendennen Peirce, DO
- Cleveland Venture Group (Visiting Angels, Living Assistance Service)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.