Healthcare Provider Details

I. General information

NPI: 1487359527
Provider Name (Legal Business Name): AUSTIN FRANK CLARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6787 LEE HWY STE 103
CHATTANOOGA TN
37421-5796
US

IV. Provider business mailing address

6787 LEE HWY STE 103
CHATTANOOGA TN
37421-5796
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-2229
  • Fax: 423-510-0048
Mailing address:
  • Phone: 423-698-2229
  • Fax: 423-510-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77091
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: