Provider Demographics
NPI:1225245814
Name:YUKON CLINIC
Entity Type:Organization
Organization Name:YUKON CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:YUKON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-755-8300
Mailing Address - Street 1:1355 W BRIERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2208
Mailing Address - Country:US
Mailing Address - Phone:901-755-8300
Mailing Address - Fax:901-755-7568
Practice Address - Street 1:1355 W BRIERBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2208
Practice Address - Country:US
Practice Address - Phone:901-755-8300
Practice Address - Fax:901-755-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26524261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center