Doctor Name: | CLYDE O SOUTHWELL |
NPI Number: | 1346288966 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 43085 |
Business Practice Address: | 353 New Shackle Island Rd Suite 140 C Hendersonville, TN - 370752379 |
Business Phone Number: | 6158222214 |
Business Fax Number: | 6158226519 |
Mailing Address: | 353 New Shackle Island Rd., Suite 140 C HENDERSONVILLE |
State: | TN |
Postal Code: | 370752379 |
Phone Number: | 6158222214 |
Fax Number: | 6158226519 |
NPI Enumeration Date: | 06/04/2006 |
NPI Last Update Date: | 04/11/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 43085 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |