Individual
STEVEN L CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
682 CANTER LN, COOKEVILLE, TN 38501-4523
(931) 526-8513
(931) 526-5422
Mailing address
DEPT. 888152, KNOXVILLE, TN 37995
(931) 526-8513
(931) 526-5422
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
37325
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203554085
FEDERAL TAX ID
—
05
—
3732052
—
TN
05
—
3882671
—
TN
01
—
4114638
BLUE CROSS BLUE SHIELD
TN
Enumeration date
07/10/2006
Last updated
10/12/2015
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