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
Phone: (865) 331-1155
Fax: (865) 331-3165
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700029626 | NPPES |
| Tennessee | MEDICAID | Q005973 |
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