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General NPI Number Information
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NPI Number | 1295941300
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Entity Type | Organization
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Legal Business Name | SCENIC CITY ORTHOPAEDICS & SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 2707 CITICO AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37406-3402
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Country | US
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Telephone | 423-624-8588
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Fax | 423-622-3069
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Provider Business Mailing Address
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Address Line | 2707 CITICO AVE
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City | CHATTANOOGA
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State | TN
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Zip | 37406-3402
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Country | US
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Telephone | 423-624-8588
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Fax | 423-622-3069
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Authorized Official
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Title or Position | OWNER
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Name | ERIC P CLARKE
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Credential | M.D.
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Telephone | 423-624-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 21142
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License Number State | TN
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