Provider Demographics
NPI:1629023890
Name:CLINE, ELIJAH G (MD)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:G
Last Name:CLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ELIJAH
Other - Middle Name:GRADY
Other - Last Name:CLINE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1431 CENTERPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2768
Practice Address - Country:US
Practice Address - Phone:423-907-1200
Practice Address - Fax:865-291-3228
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN007404207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006049OtherBCBS
TN3161415Medicaid
TN3161415Medicare ID - Type Unspecified
TNB02879Medicare UPIN
TN103I088179Medicare PIN
TNB02879Medicare PIN