Individual
KATLYN BAILEY CLARK-FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1855 TANNER WAY STE 200, HARRIMAN, TN 37748-8332
(865) 374-6272
(865) 374-2100
Mailing address
1855 TANNER WAY STE 200, HARRIMAN, TN 37748-8332
(865) 374-6272
(865) 374-2100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
71338
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q095495
—
TN
Enumeration date
05/09/2019
Last updated
08/26/2024
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