Healthcare Provider Details

I. General information

NPI: 1699150185
Provider Name (Legal Business Name): CLAYTON MARRS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2015
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 COURAGE WAY STE 101
CHATTANOOGA TN
37421-1555
US

IV. Provider business mailing address

7345 COURAGE WAY STE 101
CHATTANOOGA TN
37421-1555
US

V. Phone/Fax

Practice location:
  • Phone: 423-602-9797
  • Fax:
Mailing address:
  • Phone: 423-602-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20189
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number20189
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: