Provider Demographics
NPI:1982779385
Name:CLARDY, JOHN THOMAS SR (MD INC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:CLARDY
Suffix:SR
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3249
Mailing Address - Country:US
Mailing Address - Phone:931-503-0182
Mailing Address - Fax:931-503-0192
Practice Address - Street 1:215 8TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3249
Practice Address - Country:US
Practice Address - Phone:931-503-0182
Practice Address - Fax:931-503-0192
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000030062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB59729Medicare UPIN