Clark, Grant Michael

Clark, Grant Michael is an individual health care provider with primary practice located at 1915 White Avenue , Knoxville TN 37916-2399. He recently has only one registered license in Allopathic & Osteopathic Physicians / Radiation Oncology, which is considered as his primary health care specialty. Clark, Grant Michael can be contacted via phone (865) 331-1155.

Contact Information

Primary practice address
1915 White Avenue Knoxville TN 37916-2399
Fax: (865) 331-3165
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Radiation Oncology 2085R0001X 51020 Tennessee

Profile Details

NPI number 1700029626
LBN Legal business name Clark, Grant Michael
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 7th, 2009
Last updated Sep 8th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700029626 NPPES
Tennessee MEDICAID Q005973

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