Individual
STACEY JACK MCCLARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 E THIRD ST, CHATTANOOGA, TN 37403-2147
(423) 778-7608
(423) 778-2360
Mailing address
PO BOX 11225, CHATTANOOGA, TN 37401-2225
(423) 892-5602
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD41787
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009912228
—
AL
05
—
3000170
—
TN
01
—
4160316
BLUE CROSS BLUE SHIELD OF TN
TN
05
—
5912136
—
NC
05
—
762425491A
—
GA
01
—
N394859
WELLCARE (GA MEDICAID)
GA
01
—
P00473706
MEDICARE RAILROAD
TN
Enumeration date
03/22/2007
Last updated
01/14/2010
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