Individual
MARK S CLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9125 CROSS PARK DR, SUITE 200, KNOXVILLE, TN 37923-4505
(865) 632-5900
(865) 546-5227
Mailing address
304 WRIGHT ST, SUITE 200, SWEETWATER, TN 37874-1181
(865) 632-5900
(865) 546-5227
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
110001634
VA
363AS0400X
Surgical Physician Assistant
Primary
PA1617
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010184487
—
VA
Enumeration date
09/14/2005
Last updated
08/04/2016
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