MEDICARE: CLYDE HUGH EVERHART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	43764	TN

General Provider Information

NPI Number	:	1316943665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDE HUGH EVERHART MD

Provider Business Mailing Address
First Line	:	725 GLENWOOD DR
Second Line	:	SUITE E-500
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-1163
Country	:	US
Telephone Number	:	423-495-2635
Fax Number	:	423-495-2638

Provider Business Practice Location Address
First Line	:	725 GLENWOOD DR
Second Line	:	SUITE E-500
City	:	CHATTANOOGA
State	:	TN
Zip	:	37404-1163
Country	:	US
Telephone Number	:	423-495-2635
Fax Number	:	423-495-2638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/24/2013

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