Provider Demographics
NPI:1215372768
Name:WASSON, CLIVE ANDERSON (DO)
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:ANDERSON
Last Name:WASSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2401
Mailing Address - Country:US
Mailing Address - Phone:931-967-3966
Mailing Address - Fax:931-962-0373
Practice Address - Street 1:83 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398
Practice Address - Country:US
Practice Address - Phone:931-967-3966
Practice Address - Fax:931-962-0373
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3442208600000X
ALDO1571207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery