Healthcare Provider Details

I. General information

NPI: 1528115409
Provider Name (Legal Business Name): CLINTON ANDREW MARLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE STE 600
NASHVILLE TN
37207-2525
US

IV. Provider business mailing address

410 42ND AVE N STE 400
NASHVILLE TN
37209-3658
US

V. Phone/Fax

Practice location:
  • Phone: 615-865-0700
  • Fax: 615-865-0701
Mailing address:
  • Phone: 615-292-5722
  • Fax: 615-346-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000044476
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: