=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952693483
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM CLAYTON WRIGHT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2011
-----------------------------------------------------
Last Update Date | 01/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6516 KINGSTON PIKE
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-4825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-450-9361
-----------------------------------------------------
Fax | 865-450-9362
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | DEPT 888213
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37995-8213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-520-7996
-----------------------------------------------------
Fax | 865-450-9362
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 54440
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------