Individual provider · NPI-1

Dustin Michael Clark, M.D.

Emergency Medicine · Greeneville, TN

NPI number1285831644
StatusActive
Last updated in NPPESJul 31, 2017

Details

NPI
1285831644
Entity type
Individual (NPI-1)
Name
Dustin Michael Clark
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 29, 2007
Last updated
Jul 31, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207P00000X Emergency Medicine50872TNYes
390200000X Student in an Organized Health Care Education/Training Program––

Practice location

1420 Tusculum Blvd
Laughlin Memorial Hospital
Greeneville, TN 37745

Phone 423-787-5000

Mailing address

900 Melrose Cir
Johnson City, TN 37601-2114

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