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General NPI Number Information
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NPI Number | 1154418150
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Entity Type | Individual
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Provider Name | WILSON MONROE CLEMENTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 2108 E 3RD ST SUITE 300
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City | CHATTANOOGA
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State | TN
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Zip | 37404-2600
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Country | US
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Telephone | 423-624-5200
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Fax | 423-624-4440
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Provider Business Mailing Address
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Address Line | 2501 CITICO AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37404-1127
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Country | US
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Telephone | 423-697-2000
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Fax | 423-697-2118
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 2010-01100
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 42073
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 52593
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License Number State | TN
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