Healthcare Provider Details

I. General information

NPI: 1720929037
Provider Name (Legal Business Name): MOLLY IHLE-CLAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8245
US

IV. Provider business mailing address

123 SHORT LN
JONESBOROUGH TN
37659-4842
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-7200
  • Fax:
Mailing address:
  • Phone: 423-268-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: