Healthcare Provider Details

I. General information

NPI: 1033797352
Provider Name (Legal Business Name): WILLIAM TYLER CLEMENTS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CLINCH AVE
KNOXVILLE TN
37916-2307
US

IV. Provider business mailing address

1147 NW 64TH TER
GAINESVILLE FL
32605-4218
US

V. Phone/Fax

Practice location:
  • Phone: 865-331-1111
  • Fax:
Mailing address:
  • Phone: 352-333-5980
  • Fax: 352-333-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5661
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: