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General NPI Number Information
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NPI Number | 1619189289
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Entity Type | Organization
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Legal Business Name | THE CLEVELAND CLINIC OF TN, P.C.
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 55 BEN DR NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3897
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Country | US
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Telephone | 423-472-1991
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Fax | 423-339-2321
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Provider Business Mailing Address
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Address Line | PO BOX 11052
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City | CHATTANOOGA
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State | TN
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Zip | 37401-2052
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Country | US
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Telephone | 423-472-1991
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Fax | 423-339-2321
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | KAVIN JOHNSON
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Credential | MD
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Telephone | 423-472-1991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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