Healthcare Provider Details

I. General information

NPI: 1750572830
Provider Name (Legal Business Name): CLIFFORD DAVIDSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 MIDDLEBROOK PIKE
KNOXVILLE TN
37909-3139
US

IV. Provider business mailing address

7328 MIDDLEBROOK PIKE
KNOXVILLE TN
37909-3139
US

V. Phone/Fax

Practice location:
  • Phone: 865-769-2600
  • Fax: 865-769-2616
Mailing address:
  • Phone: 865-769-2600
  • Fax: 865-769-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD24206
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: