Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 50950 | TN |
NPI | 1013276039 |
---|---|
Provider Name | Clint Austin Christensen |
First Address | Chattanooga, TN 37421-7137 |
Second Address | Chattanooga, TN 37421-7137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 13/03/2017 |