Individual
DR. GRANT MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1915 WHITE AVENUE, KNOXVILLE, TN 37916-2399
(865) 331-1155
(865) 331-3165
Mailing address
P.O. BOX 24120, KNOXVILLE, TN 37933-2120
(865) 803-4321
(865) 988-5658
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
51020
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q005973
—
TN
Enumeration date
04/07/2009
Last updated
09/08/2023
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