Clark, Jonathan

Clark, Jonathan is an individual health care provider with primary practice located at 1 Medical Park Blvd Ste 300E, Bristol TN 37620-7497. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Orthopaedic Surgery. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Clark, Jonathan can be contacted via phone (423) 844-6450.

Contact Information

Primary practice address
1 Medical Park Blvd Ste 300E Bristol TN 37620-7497
Phone: (423) 844-6450
Fax: (423) 844-6499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X ME123118 Florida

Profile Details

NPI number 1033437330
LBN Legal business name Clark, Jonathan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2010
Last updated Nov 21st, 2016 - about 10 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 1033437330 NPPES
Tennessee MEDICAID Q023678
Tennessee MEDICAID 014980500

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