DOUGLAS CLARK (NPI# 1487756755) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487756755 |
| Entity Type | Organization |
| Organization Name | DOUGLAS CLARK |
| Other Organization Name | COMMUNITY CARE WALK IN CLINIC |
| Practice Address |
2317 South Roane Street Harriman TN 37748 |
| Practice Telephone | 8655900072 |
| Practice Fax Number | 8655900069 |
| Mailing Telephone | 8655900072 |
| Mailing Fax Number | 8655900069 |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DOUGLAS MARLEY CLARK (OWNER) |
| Authorized Official Telephone | 8655900072 |
| Authorized Official Credential | PAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MCARE | DB1921 | 01 | |
| TN | 3723702 | 05 |
| Other Name | Type Code |
|---|---|
| Community Care Walk In Clinic | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | DOUGLAS CLARK LLC | 814 10th Avenue, #4f, New York, New York 10019 |
| Street Address |
2317 SOUTH ROANE STREET |
| City | HARRIMAN |
| State | TN |
| Zip Code | 37748 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063904324 | Jared Michael Orick | Nurse Practitioner | 1855 Tanner Way Ste 110, Harriman, TN 37748 | 2018-06-03 |
| 1447769062 | Jonni Rhea Wood | Nurse Practitioner | 2497 S Roane St Ste 110, Harriman, TN 37748 | 2017-09-26 |
| 1396173423 | Roane Urgent Care Clinic LLC | Clinic/Center | 2497 S. Roane St, Suite 110 B, Harriman, TN 37748 | 2013-10-29 |
| 1861837080 | Rebecca T Jordan | Community Health Worker | 257 Patton Lane, Harriman, TN 37748 | 2013-05-01 |
| 1891944765 | Kristine Joan Dyer | Nurse Practitioner | 8045 Roane Medical Center Drive, Harriman, TN 37748 | 2008-09-15 |
| 1104047703 | Doyle Alfred Griffis | Pharmacist | 319 N. Roane Street, Harriman, TN 37748 | 2007-05-01 |
| 1629107651 | Paula A Margrave | Pharmacist | Roane Plaza Hwy 27, Food City Pharmacey #634, Harriman, TN 37748 | 2007-03-05 |
| 1952471476 | Roane Chiropractic Center | Chiropractor | 1208 South Roane Street, Harriman, TN 37748 | 2006-11-09 |
| 1588681068 | K Va T Food Stores Inc | Durable Medical Equipment & Medical Supplies | 1130 S Roane Street, Hwy. 27, Harriman, TN 37748 | 2006-07-17 |
| 1750312344 | Marty Green Wallace | Family Medicine | 415 Devonia Street, Suite 101, Harriman, TN 37748 | 2006-07-05 |
| Find all providers in zip 37748 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700995206 | Nickola Snow Jefferson | Family Medicine | 240 Hannah Rd, Harriman, TN 37748-5851 | 2006-08-29 |
| 1750312344 | Marty Green Wallace | Family Medicine | 415 Devonia Street, Suite 101, Harriman, TN 37748 | 2006-07-05 |
| 1073568218 | Mancel Wayne Wakham | Family Medicine | 2497 S. Roane St., Suite 110, Harriman, TN 37748 | 2006-05-24 |
| 1609857614 | Steven Alan Crews | Family Medicine | 2305 N Gateway Ave Unit 2, Harriman, TN 37748-8709 | 2005-11-07 |
| 1609863422 | Miriam B Tedder | Family Medicine | 525a Devonia St, Harriman, TN 37748-2116 | 2005-10-06 |
| 1750377826 | Clary Parker Foote | Family Medicine | 190 N Roane St, Harriman, TN 37748-2017 | 2005-09-23 |
| 1326034398 | Clary Foote Md PC | Family Medicine | 2319 S Roane St, Harriman, TN 37748-8653 | 2005-09-23 |
| 1982698155 | Robert Joseph Wilson | Family Medicine | 1855 Tanner Way, Harriman, TN 37748-8302 | 2005-09-02 |
| 1003319237 | Summit Medical Group, Pllc | Family Medicine | 2497 S Roane St Ste 110, Harriman, TN 37748-8666 | 2018-03-14 |
| 1215318951 | Spenser Wolken | Family Medicine | 8045 Roane Medical Center Dr, Harriman, TN 37748-8333 | 2015-06-17 |
| Find all providers in HARRIMAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.