Individual
CLYDE O SOUTHWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 WESSINGTON PL, HENDERSONVILLE, TN 37075-3085
(615) 822-2214
Mailing address
3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 37072-3132
(615) 239-2018
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
43085
TN
207RP1001X
Pulmonary Disease Physician
Primary
43085
TN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
43085
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0404464
EVERCARE
NC
01
—
14014
BCBS PROVIDER#
NC
01
—
184386
MEDCOST PROVIDER#
NC
05
—
5902491
—
NC
01
—
FH2967215
FCC PROVIDER#
NC
01
—
N01356
SC MEDICAID PROVIDER#
SC
01
—
P00278679
PALMETTO GBA PROVIDER#
NC
Enumeration date
06/04/2006
Last updated
01/21/2025
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