Healthcare Provider Details

I. General information

NPI: 1851394191
Provider Name (Legal Business Name): CHRISTOPHER COLUMBUS MCCLURE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

647 DUNLOP LN STE 200
CLARKSVILLE TN
37040-5165
US

IV. Provider business mailing address

647 DUNLOP LN STE 200
CLARKSVILLE TN
37040-5165
US

V. Phone/Fax

Practice location:
  • Phone: 931-648-0064
  • Fax: 931-553-4215
Mailing address:
  • Phone: 931-648-0064
  • Fax: 931-553-4215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20760
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: