Healthcare Provider Details

I. General information

NPI: 1750377826
Provider Name (Legal Business Name): CLARY PARKER FOOTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N ROANE ST
HARRIMAN TN
37748-2017
US

IV. Provider business mailing address

190 N ROANE ST
HARRIMAN TN
37748-2017
US

V. Phone/Fax

Practice location:
  • Phone: 865-882-2800
  • Fax: 865-882-3512
Mailing address:
  • Phone: 865-882-2800
  • Fax: 865-882-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11820
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: