MEDICARE: JOSHUA DAVID CLARK-FUQUA 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	207Q00000X	Family Medicine Physician	71339	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427613223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA DAVID CLARK-FUQUA MD

Provider Business Mailing Address
First Line	:	1855 TANNER WAY STE 200
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-8332
Country	:	US
Telephone Number	:	865-376-6272
Fax Number	:	864-560-1565

Provider Business Practice Location Address
First Line	:	1855 TANNER WAY STE 200
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-8332
Country	:	US
Telephone Number	:	865-376-6272
Fax Number	:	864-560-1565

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

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	08/26/2024

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