Healthcare Provider Details

I. General information

NPI: 1881773778
Provider Name (Legal Business Name): MARK ALLEN CLYMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MALLORY LN STE A3
BRENTWOOD TN
37027
US

IV. Provider business mailing address

1800 MALLORY LN STE A3
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-4005
  • Fax: 615-661-4005
Mailing address:
  • Phone: 615-661-4005
  • Fax: 615-661-4015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD0000024947
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: