Provider Demographics
NPI:1215126644
Name:JOHN T CLARDY SR MD INC
Entity type:Organization
Organization Name:JOHN T CLARDY SR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSCIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CLARDY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-503-0182
Mailing Address - Street 1:215 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3249
Mailing Address - Country:US
Mailing Address - Phone:931-503-0182
Mailing Address - Fax:931-503-0192
Practice Address - Street 1:215 8TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3249
Practice Address - Country:US
Practice Address - Phone:931-503-0182
Practice Address - Fax:931-503-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030062207QA0505X, 207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38298152Medicaid
TN38298151Medicaid