Provider Demographics
NPI:1053348037
Name:KINGSLEY, CLINT DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:DANIEL
Last Name:KINGSLEY
Suffix:
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:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:256-705-4224
Mailing Address - Fax:256-705-4135
Practice Address - Street 1:180 COX CREEK PKWY S STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-3263
Practice Address - Country:US
Practice Address - Phone:256-760-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49477207RH0003X
AL25035207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51012794OtherBLUE CROSS OF ALABAMA
AL510-50070OtherBCBS OF ALABAMA
AL51547906OtherBLUE CROSS OF ALABAMA
AL104703Medicaid
AL102961Medicaid
TN1528883Medicaid
AL510I110169OtherMEDICARE NUMBER
ALCA0084OtherRR MEDICARE
ALP00657989OtherRR MEDICARE NUMBER
AL528701110Medicaid
AL102961Medicaid