Provider Demographics
NPI:1891767794
Name:MACCONNELL, CLAYTON M (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:M
Last Name:MACCONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:110 SAINT BLAISE RD STE 200
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4594
Practice Address - Country:US
Practice Address - Phone:615-230-8070
Practice Address - Fax:615-452-1774
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD17254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3021676Medicaid
TN3021676Medicare ID - Type Unspecified
TN3021676Medicaid