Individual
GUY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
601 S CONCORD ST STE 108, KNOXVILLE, TN 37919-3339
(865) 292-3000
Mailing address
601 S CONCORD ST STE 108, KNOXVILLE, TN 37919-3339
(931) 761-5732
(931) 761-8661
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101047497
VA
207R00000X
Internal Medicine Physician
Primary
MD20063
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010256267
—
VA
05
—
64666985
—
KY
01
—
P00255508
MEDICARE RAILROAD
VA
05
—
Q064419
—
TN
Enumeration date
07/05/2006
Last updated
05/25/2021
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