Provider Demographics
NPI:1386889301
Name:RADCLIFFE, AILENE FAY (LMT)
Entity type:Individual
Prefix:MRS
First Name:AILENE
Middle Name:FAY
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 ARROWHEAD TRL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-7003
Mailing Address - Country:US
Mailing Address - Phone:865-406-1143
Mailing Address - Fax:865-482-0959
Practice Address - Street 1:665 EMORY VALLEY RD
Practice Address - Street 2:STE. A
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7762
Practice Address - Country:US
Practice Address - Phone:865-482-0981
Practice Address - Fax:865-482-0959
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000003279172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker