MEDICARE: WILLIAM HARDEE MCCLATCHY 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	09637	MS

General Provider Information

NPI Number	:	1871592659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM HARDEE MCCLATCHY MD

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7163 GOODMAN RD
Second Line	:
City	:	OLIVE BRANCH
State	:	MS
Zip	:	38654-1904
Country	:	US
Telephone Number	:	662-893-7878
Fax Number	:	662-874-1391

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/05/2024

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