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General NPI Number Information
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NPI Number | 1255469235
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Entity Type | Organization
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Legal Business Name | CLEVELAND HEAD & NECK CLINIC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2414 CHAMBLISS AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3879
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Country | US
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Telephone | 423-472-6581
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Fax | 423-472-2425
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Provider Business Mailing Address
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Address Line | 2414 CHAMBLISS AVE NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3879
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Country | US
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Telephone | 423-472-6581
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Fax | 423-472-2425
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK BYRD
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Credential | MD
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Telephone | 423-472-6581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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