Individual
TAVIS D. CLONCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
701 MED TECH PKWY STE 300, JOHNSON CITY, TN 37604-2365
(423) 232-8301
(423) 232-8304
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 952-2111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110009515
VA
363A00000X
Physician Assistant
Primary
5560
TN
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/12/2023
Last updated
06/15/2026
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