Provider Demographics
NPI:1023247566
Name:MCCLINTON, ERNEST (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:MCCLINTON
Suffix:
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 1:621 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301
Mailing Address - Country:US
Mailing Address - Phone:731-541-6280
Mailing Address - Fax:
Practice Address - Street 1:601 W MAPLE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-750-6585
Practice Address - Fax:479-757-2963
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49405207P00000X
ARE6788207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program