Provider Demographics
NPI:1043385453
Name:CLARDY, GEORGE THOMAS JR (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:CLARDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:931-542-9010
Mailing Address - Fax:931-542-9019
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:931-542-9010
Practice Address - Fax:931-542-9019
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000038161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1043385453OtherNPPES
TN4131289Medicaid
TN4131289Medicaid
TN3337950Medicare ID - Type Unspecified
TN4131289Medicaid