Individual
CLARENCE E GOULDING III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 MED TECH PKWY, SUITE 108, JOHNSON CITY, TN 37604-2278
(423) 915-5033
(423) 952-3777
Mailing address
200 MED TECH PKWY, SUITE 108, JOHNSON CITY, TN 37604-2278
(423) 915-5033
(423) 952-3777
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
15893
TN
207Q00000X
Family Medicine Physician
15893
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3017571
—
TN
Enumeration date
10/23/2006
Last updated
02/02/2017
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