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1124525423 NPI number — ELLEN CLARA CLELAND MD

NPI Number: 1124525423
Health Care Provider/Practitioner: ELLEN CLARA CLELAND MD

Information about “1124525423” NPI (ELLEN CLARA CLELAND MD) exists in 1124525423 in HTML format HTML  |  1124525423 in plain Text format TXT  |  1124525423 in PDF (Portable Document Format) PDF  |  1124525423 in an XML format XML  formats.

NPI Number : 1124525423 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124525423",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLELAND",
    "FirstName": "ELLEN",
    "MiddleName": "CLARA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1949 GUNBARREL RD STE 206",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHATTANOOGA",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37421-7133",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-495-3671",
    "MailingAddressFaxNumber": "423-495-4934",
    "FirstLinePracticeLocationAddress": "1949 GUNBARREL RD STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHATTANOOGA",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37421-7133",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-648-8110",
    "PracticeLocationAddressFaxNumber": "423-443-4297",
    "EnumerationDate": "04/12/2018",
    "LastUpdateDate": "07/13/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "63627",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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